Leon Barnes v. WEXFORD HEALTH SOURCES , INC ., EVARISTO P. AGUINALDO, JR ., and ESTATE OF SALEH OBAISI

In the
United States Court of Appeals
For the Seventh Circuit
____________________
No. 24-2080
LEON BARNES ,
Plaintiff-Appellant,
v.
WEXFORD HEALTH S OURCES , I NC .,
EVARISTO P. A GUINALDO, JR .,
and ESTATE OF S ALEH O BAISI
Defendants-Appellees.
____________________
Appeal from the United States District Court for the
Northern District of Illinois, Eastern Division.
No. 17-cv-8959 — Franklin U. Valderrama, Judge.
____________________
A RGUED A PRIL 9, 2025 — DECIDED J UNE 1, 2026
____________________
Before EASTERBROOK, J ACKSON -A KIWUMI , and PRYOR , Cir-
cuit Judges.
PRYOR , Circuit Judge. Leon Barnes, an inmate in the cus-
tody of the Illinois Department of Corrections (IDOC), suf-
fered from internal prolapsed hemorrhoids during his time at
one of the state’s prison facilities. After receiving a

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2 No. 24-2080
hemorrhoidectomy, Barnes launched this lawsuit under 42
U.S.C. § 1983 against Wexford Health Sources, Inc. (Wexford),
the Illinois Department of Corrections’s contracted medical
provider, Doctor Evaristo Aguinaldo, M.D., and the Inde-
pendent Executor of the Estate of Doctor Saleh Obaisi, M.D.
(collectively Defendants).1 Barnes contends Defendants vio-
lated his Eighth Amendment rights because they were delib-
erately indifferent to his serious medical condition. The dis-
trict court granted summary judgment to Defendants, hold-
ing Barnes failed to submit sufficient evidence for a jury to
find in his favor.
Barnes appeals, arguing the district court erred in granting
summary judgment to Defendants. In his view, the actions, or
inactions, of Dr. Aguinaldo and Dr. Obaisi delayed his pre-
ferred care—receiving surgery for his hemorrhoids. He also
alleges that Wexford’s collegial review and referral processes
aided in the delays by the doctors. We disagree and affirm.
I. BACKGROUND
A. Factual Background
Barnes is a prisoner who has been a resident inmate
throughout the Illinois Prison system since 2005. During the
relevant time of the events underlying his lawsuit, Barnes was
housed at Stateville Correctional Center (Stateville) from
April 6, 2016, to July 25, 2018, and was then transferred to Hill
Correctional Center (Hill). While housed at Stateville, Barnes
suffered from prolapsed hemorrhoids, which he started expe-
riencing in 2013.
1 Dr. Obaisi passed away in late 2017 and an estate was opened by his
Executor.

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No. 24-2080 3
Wexford contracts with the Illinois Department of Correc-
tions to provide medical, dental, vision, pharmaceutical, and
mental health services for prisoners at Stateville and Hill.
Wexford arranges and provides these services onsite at the
prison institution and, as necessary, offsite at local hospitals,
outpatient facilities, and consultative physician offices. When
an onsite physician refers an inmate for care outside of the
correctional institution, the referral goes through a process
known as “collegial review.” Collegial review takes place
during a scheduled conference call between Wexford’s corpo-
rate director of utilization management and, at a minimum,
the institution’s medical director.
Occasionally, the onsite physician requesting care outside
of the correctional institution as well as other Wexford physi-
cians attend the call. During the conference call, a Stateville
representative seeks approval to have an inmate referred out
to an offsite provider for services. The request is approved or
denied. The offsite providers, for their part, can refuse or ac-
cept the inmate for care, and if refused, Wexford has no au-
thority to force them to accept the inmate.
On July 29, 2016, Barnes was seen by Dr. Aguinaldo—an
onsite physician at Stateville—complaining of hemorrhoids.
Dr. Aguinaldo noted Barnes was not in distress, conducted a
rectal exam, found no external hemorrhoids, and conducted
an occult blood test, which was negative for blood in Barnes’s
stool. About two months later, Barnes was seen by Dr. Obaisi,
who prescribed Barnes a fiber supplement called Fiberlax for

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4 No. 24-2080
his hemorrhoids. While Barnes was at Stateville, Dr. Obaisi
also served as the medical director.2
On January 10, 2017, Barnes saw Dr. Obaisi again, com-
plaining of rectal bleeding and pain during bowel move-
ments. Dr. Obaisi sought collegial review for Barnes to receive
an evaluation of colorectal anal fissure and bleeding, and
Wexford approved the collegial review on January 18, 2017.
On June 19, 2017, Barnes was sent out on a medical furlough
to the University of Illinois Hospital in Chicago (UIC) where
he saw Dr. Nordenstam, a colorectal surgeon and professor of
surgery, who noted a prolapse of Barnes’s internal hemor-
rhoids. Barnes was scheduled for a radiological exam and pre-
scribed a different fiber supplement, Metamucil.
On June 27, 2017, Dr. Obaisi sought collegial review of
Barnes’s radiological exam, and it was approved by Wexford
the same day. On September 15, 2017, Barnes had his radio-
logical exam, which revealed that he had mild to moderate
rectal distention on evacuation. The diagnosis was prolapsing
internal hemorrhoids but no rectal prolapse. Barnes had been
2 It is undisputed that a person can take fiber supplements, or consume
fiber and drink lots of fluids, to reduce pain associated with all forms of
hemorrhoids. Before the district court, Barnes attempted to dispute this
fact but agreed “such treatment may be sufficient for” certain hemor-
rhoids and that for more severe hemorrhoids “more aggressive treatment
is likely necessary.” Given Barnes failed to cite evidence in support of his
response, the district court determined Barnes failed to comply with the
Northern District of Illinois’s Local Rule 56.1 and deemed this fact admit-
ted. Barnes v. Wexford Health Sources, Inc., No. 17-cv-8959, 2022 WL
20288624, at *2, n.6 (N.D. Ill. Nov 23, 2022). On appeal, Barnes does not
contest the district court’s decision to do so; therefore, we too deem the
fact admitted. See, e.g., Flint v. City of Belvidere, 791 F.3d 764, 766–67 (7th
Cir. 2015).

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No. 24-2080 5
straining with bowel movements, which made the hemor-
rhoids prolapse worse.
That same month, Barnes was sent out to UIC for a follow-
up with Dr. Nordenstam, who recommended pelvic floor/bi-
ofeedback therapy before he would consider Barnes for a
hemorrhoidectomy—a surgical procedure to remove hemor-
rhoids. Dr. Nordenstam did not want to perform the surgery
before Barnes completed pelvic floor therapy because he be-
lieved surgery would not provide a long-term solution if
Barnes was not having proper bowel movements. Dr. Nor-
denstam also did not place a timeline on when the surgery
needed to happen.
The day after Barnes’s follow-up appointment with Dr.
Nordenstam, on September 26, 2017, Dr. Obaisi signed a form
titled “Illinois Department of Corrections Medical Special Ser-
vices Referral and Report” seeking collegial review for “Rec-
tal biofeedback Training at UIC Colorectal clinic [with]
Dr. Nordenstam” for Barnes. Wexford approved the referral
on October 3, 2017. But after the therapy was approved
through collegial review, UIC chose not to accept Barnes for
the therapy, as was within its discretion.
On October 19, 2017, Barnes saw Dr. Aguinaldo for com-
plaints of strep throat and other cold-like symptoms but did
not complain of hemorrhoid issues. Dr. Aguinaldo saw
Barnes again on March 6, 2018, to determine whether to re-
new Barnes’s shower permit. Dr. Aguinaldo noted Barnes’s
history of rectal obstruction and his prior appointment at UIC
in September 2017 for the issue. Dr. Aguinaldo renewed the
shower permit and issued Barnes an ice permit.

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6 No. 24-2080
On April 9, 2018, Dr. Okezie—the medical professional
who served as medical director at Stateville after Dr. Obaisi—
issued a referral to collegial review for pelvic floor therapy for
Barnes at UIC which was denied because UIC would not ac-
cept Barnes for this therapy.
A few months later, on August 14, 2018, after Barnes was
transferred to Hill, Dr. Bautista—a traveling medical direc-
tor—issued another referral to collegial review for pelvic floor
therapy which Wexford approved. Barnes was then sent out
on medical furlough on September 11, 2018, at a different
medical facility—Cottage Rehabilitation and Sports Medi-
cine—to begin pelvic floor therapy. Barnes completed pelvic
floor therapy at Cottage on October 23, 2018, and on March
25, 2019, Dr. Matthew at UIC recommended Barnes undergo
a hemorrhoidectomy. Wexford approved the surgery on
April 4, 2019, and Barnes underwent the hemorrhoidectomy
on April 16, 2019.
B. Procedural History
Barnes filed suit under 42 U.S.C. § 1983 against Dr. Obaisi
and Dr. Aguinaldo, alleging Dr. Obaisi and Dr. Aguinaldo
were deliberately indifferent to his prolapsed hemorrhoids in
violation of the Eighth Amendment. Barnes also asserted a
Monell claim against Wexford, contending its actions uncon-
stitutionally delayed his hemorrhoidectomy. After discovery,
Defendants moved for summary judgment.
In ruling on the motion, the district court found for De-
fendants on Barnes’s claims of deliberate indifference and on
his Monell claim against Wexford due to his failure to submit
evidence to support his claims. Specifically, the district court
found Barnes failed to submit evidence that any of

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No. 24-2080 7
Dr. Obaisi’s actions evinced deliberate indifference. It also
found that Barnes needed verifying medical evidence that a
delay of pelvic floor therapy caused him harm, but he failed
to put forth such evidence. As for Dr. Aguinaldo, the court
found Barnes could not establish deliberate indifference. Fi-
nally, it found no Monell claim because Barnes failed to show
Wexford’s actions—or the collegial review process—was the
moving force behind any constitutional violation.
II. A NALYSIS
On appeal, Barnes challenges the district court’s grant of
summary judgment to Defendants. He contends Dr. Obaisi
and Dr. Aguinaldo were deliberately indifferent to his pro-
lapsed hemorrhoids. He also maintains that he asserted a
proper Monell claim to survive summary judgment.
We review a district court’s grant of summary judgment
de novo, viewing the evidence in the light most favorable to
the nonmovant, Barnes, and drawing all reasonable infer-
ences in his favor. Carmody v. Bd. of Trs. of Univ. of Ill., 893 F.3d
397, 401 (7th Cir. 2018). To that end, Barnes, the nonmovant
must “produc[e] evidence that is more than ‘merely colora-
ble,’ [but supports] that there is a genuine issue for trial.” Om-
nicare, Inc. v. UnitedHealth Grp., Inc., 629 F.3d 697, 705 (7th Cir.
2011) (citing Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 249
(1986)). Inferences “that are supported by only speculation or
conjecture will not defeat a summary judgment motion.” Car-
mody, 893 F.3d at 401 (quoting Design Basics, LLC v. Lexington
Homes, Inc., 858 F.3d 1093, 1099 (7th Cir. 2017)). All said, sum-
mary judgment is proper “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.” Id. (quoting F ED. R.
C IV. P. 56(a)). A dispute of fact is genuine “if the evidence is

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8 No. 24-2080
such that a reasonable jury could return a verdict for the non-
moving party.” Lord v. Beahm, 952 F.3d 902, 903 (7th Cir. 2020)
(quoting Anderson, 477 U.S. at 248).
A. Deliberate Indifference
The Eighth Amendment “obligates prison officials to pro-
vide medical care to prisoners in their custody.” Clemons v.
Wexford Health Sources, Inc., 106 F.4th 628, 635 (7th Cir. 2024)
(quoting Dean v. Wexford Health Sources, Inc., 18 F.4th 214, 234
(7th Cir. 2021)). So, “a prison official’s ‘deliberate indifference
to serious medical needs of prisoners’ violates the Eighth
Amendment.” Id. (alteration accepted) (quoting Whiting v.
Wexford Health Sources, Inc., 839 F.3d 658, 661–62 (7th Cir.
2016)). Evaluating such a claim requires us to “perform a two-
step analysis, first examining whether a plaintiff suffered
from an objectively serious medical condition[] and then de-
termining whether the individual defendant was deliberately
indifferent to that condition.” Id. (quoting Petties v. Carter, 836
F.3d 722, 727–28 (7th Cir. 2016) (en banc)).
The first step is not in dispute, leaving only the second.
“Deliberate indifference is a subjective standard that is met if
a defendant either ‘knows of and disregards an excessive risk
to inmate health or safety’ or ‘is both aware of facts from
which the inference could be drawn that a substantial risk of
serious harm exists, and he draws the inference.’” Jackson v.
Esser, 105 F.4th 948, 961 (7th Cir. 2024) (quoting Johnson v.
Dominguez, 5 F.4th 818, 824–25 (7th Cir. 2021)). Therefore, in
undertaking this inquiry, we consider “the totality of an in-
mate’s medical care when considering whether that care evi-
dences deliberate indifference to serious medical needs.” Ri-
ley v. Waterman, 126 F.4th 1287, 1295 (7th Cir. 2025) (quoting
Petties, 836 F.3d at 728).

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No. 24-2080 9
“Where the evidence shows that a decision was based on
medical judgment, a jury may not find deliberate indifference,
even if other professionals would have handled the situation
differently.” Clemons, 106 F.4th at 635 (alteration accepted)
(quoting Dean, 18 F.4th at 241). Moreover, evidence indicating
“medical negligence, a mistake in professional judgment, or
even objective recklessness” does not suffice. Id. A prisoner
must instead “demonstrate that the medical professional’s re-
sponse was ‘so inadequate that it demonstrated an absence of
professional judgment.’” Jackson, 105 F.4th at 961–62 (quoting
White v. Woods, 48 F.4th 853, 862 (7th Cir. 2022)).
But on the other hand, “where evidence exists that the de-
fendants knew better than to make the medical decisions that
they did, a jury should decide whether or not the defendants
were actually ignorant to the risk of the harm that they
caused.” Clemons, 106 F.4th at 635 (alteration accepted) (quot-
ing Petties, 836 F.3d at 730–31). To that point, evidence reveal-
ing the defendant knew not to make a medical decision can
include “the obviousness of the risk from a particular course
of medical treatment; the defendant’s persistence in a course
of treatment known to be ineffective; or proof that the defend-
ant’s treatment decision departed so radically from accepted
professional judgment, practice, or standards.” Id. at 635–36
(quoting Whiting, 839 F.3d at 663).
1. Dr. Obaisi
Barnes asserts the district court failed to credit his testi-
mony as admissible evidence that Dr. Obaisi was deliberately
indifferent. He testified that Dr. Obaisi
[K]new [the] pain and suffering I was in, knew
[of] the medical condition of prolapsing

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10 No. 24-2080
hemorrhoid. He refused to treat me and refused
to approve treatment for me. Obaisi also con-
doned and followed all of [Wexford’s] proce-
dures, which is what helped him . . . which
caused him as part of the reason not to approve
the treatment for me.3
In Barnes’s view, his testimony shows that Dr. Obaisi did not
act swiftly enough and delayed his hemorrhoidectomy. But
Barnes’s testimony here is not enough at summary judgment
to show that Dr. Obaisi’s action or inaction constituted delib-
erate indifference.
To the extent that Barnes asserts his testimony shows
nothing was done for him at all, the evidence reveals the op-
posite, and he cannot prove deliberate indifference on the
grounds that he wanted Dr. Obaisi to take some other course
of action than he took so long as the action was based on med-
ical judgment. Clemons, 106 F.4th at 636–37; Arce v. Wexford
Health Sources Inc., 75 F.4th 673, 681 (7th Cir. 2023). The evi-
dence here demonstrates Dr. Obaisi exercised medical judg-
ment when he prescribed Barnes fiber supplements to ease
the pain of his hemorrhoids until his referrals were approved
by the collegial review board. Clemons, 106 F.4th at 636–37.
Prescribing fiber supplements is a common treatment proto-
col to help a patient avoid pain associated with having hem-
orrhoids—as Dr. Nordenstam testified.4 Based on this, we
cannot say that Dr. Obaisi was deliberately indifferent on the
grounds that he prescribed medication commonly used to
3 Dkt. 115-1, Barnes’s Depo., at 40.
4 Dkt. 115-5, Dr. Nordenstam’s Depo., at 8.

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No. 24-2080 11
relieve hemorrhoid pain. See id. at 637 (noting that deliberate
indifference must show “treatment decisions so unacceptable
that ‘no minimally competent professional would have so re-
sponded under those circumstances’” (quoting Jackson v.
Kotter, 541 F.3d 688, 698 (7th Cir. 2008))).
Next, Barnes argues the district court, in rejecting his de-
liberate indifference claim against Dr. Obaisi, improperly de-
termined medical evidence was necessary to evaluate
whether the delay in surgery itself caused him continued
pain. But this is a nonstarter.
“In cases such as this one—where the plaintiff alleges the
defendant delayed, rather than denied, medical treatment—
we have required that the plaintiff present ‘verifying medical
evidence’ that the delay, and not the underlying condition,
caused some harm.” Walker v. Wexford Health Sources, Inc., 940
F.3d 954, 964 (7th Cir. 2019) (quoting Jackson v. Pollion, 733
F.3d 786, 790 (7th Cir. 2013)). Barnes has failed to make that
requisite showing here. He did not put forth any verifying
medical evidence to support his claim. He only submits that
he had an internal prolapsed hemorrhoid and that he was still
in pain even though he was taking the fiber supplements.
That is not enough for his claim to survive summary judg-
ment. Evidence demonstrating the defendant reasonably re-
sponded to the risk, even if unsuccessfully preventing the
harm, “negates an assertion of deliberate indifference.” Reck
v. Wexford Health Sources, Inc., 27 F.4th 473, 483 (7th Cir. 2022)
(quoting Rasho v. Jeffreys, 22 F.4th 703, 710 (7th Cir. 2022)).
To be sure, we have found that a delay in necessary care
for a prisoner’s medical condition causing the prisoner pro-
longed pain can stand as an act of deliberate indifference.
Gomez v. Randle, 680 F.3d 859, 865–66 (7th Cir. 2012) (holding

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12 No. 24-2080
that the plaintiff stated an Eighth Amendment deliberate in-
difference claim because “even though [the four-day] delay
[in treatment for plaintiff’s infected gunshot wound] did not
exacerbate [the plaintiff’s] injury, he experienced prolonged,
unnecessary pain as a result of a readily treatable condition”);
Edwards v. Snyder, 478 F.3d 827, 831 (7th Cir. 2007) (a plaintiff
who dislocated his finger, and suffered immense pain, and
was denied treatment for two days properly presented a de-
liberate-indifference claim). But because a showing of a delay,
in isolation, is insufficient to support a deliberate indifference
claim, a prisoner must offer verifying medical evidence that
shows that the delay was detrimental. Williams v. Liefer, 491
F.3d 710, 715 (7th Cir. 2007) (finding that “expert testimony
that the [prisoner] suffered because of a delay in treatment”
could serve as verifying medical evidence). Thus, “evidence
of a plaintiff’s diagnosis and treatment, standing alone, is in-
sufficient if it does not assist the jury in determining whether
a delay exacerbated the plaintiff’s condition or otherwise
harmed him.” Id. (citation omitted); see Langston v. Peters, 100
F.3d 1235, 1240 (7th Cir. 1996) (affirming summary judgment
when plaintiff failed to show any evidence that a one-hour
delay in treatment was detrimental to him).
Again, Barnes did not offer verifying medical evidence
here, so this argument fails.
Finally, Barnes also contends Dr. Obaisi’s failure to
promptly get him the treatment Dr. Nordenstam prescribed,
i.e., pelvic floor therapy and the resultant hemorrhoidectomy,
constitutes a delay. Fatal to his arguments, Barnes relies on
nothing more than his diagnosis and ultimate treatment to
support his argument the delay caused him harm, but that
alone cannot evidence harm stemming from the delay itself.

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No. 24-2080 13
See Williams, 491 F.3d at 715. The record, too, undermines
Barnes’s position. Dr. Obaisi gave Barnes a fiber supplement
to help relieve his pain while awaiting approval to send him
out for evaluation and treatment. Dr. Nordenstam also pre-
scribed Barnes a fiber supplement supporting that Dr. Obaisi
responded to Barnes’s hemorrhoid issue at least in the same
way as Dr. Nordenstam. See Walker, 940 F.3d at 965; Clemons,
106 F.4th at 636–37 (recognizing that symmetry of treatment
by multiple professionals undermines a claim of deliberate in-
difference). As stated above, that evinces Dr. Obasi “re-
sponded reasonably in treating” Barnes’s “condition—even
with the delay.” Clemons, 106 F.4th at 636.
Additionally, Dr. Obaisi ordered Barnes a bland diet at his
request and referred Barnes out for offsite evaluation and
multiple other medical follow-ups based on the offsite physi-
cians’ recommendations. See Walker, 940 F.3d at 965 (finding
no deliberate indifference where medical provider “made re-
ferrals and re-referrals when necessary, all the while treating
[the plaintiff’s] symptoms”). No evidence demonstrates
Dr. Obaisi had any role in Barnes not receiving physical ther-
apy or surgery after he referred Barnes out for treatment. See
id. at 966 (recognizing that lack of medical provider’s personal
involvement in treatment delays counsels against a finding of
deliberate indifference). And more than that, Dr. Nordenstam
attested that he, as the offsite physician, did not place a time-
line on when Barnes needed to have his hemorrhoidectomy.
That illustrates Dr. Obaisi did not cause any delay of Barnes’s
pelvic floor therapy and surgery. Without evidence showing
that the delay in treatment for Barnes’s continued hemor-
rhoids harmed him, we will not simply assume so. See Lang-
ston, 100 F.3d at 1240.

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14 No. 24-2080
In sum, because Barnes fails to point to evidence that
Dr. Obaisi was deliberately indifferent to his medical needs,
the district court properly granted summary judgment for
Dr. Obaisi.
2. Dr. Aguinaldo
Turning now to Dr. Aguinaldo, in Barnes’s opening brief
to this Court, he failed to provide arguments against the dis-
trict court’s grant of summary judgment to Dr. Aguinaldo.
Even though he mentioned Dr. Aguinaldo in the opening
brief’s headings, his arguments were focused solely on
Dr. Obaisi. But in his reply brief, Barnes argues he did not
waive his claims against Dr. Aguinaldo because his opening
brief mentions that Dr. Aguinaldo replaced Dr. Obaisi after
his passing and includes Barnes’s testimony that no one did
anything for him. In his view, general claims such as those are
enough to show he challenged the grant of summary judg-
ment to Dr. Aguinaldo in his opening brief.
In this Circuit, a party may not raise arguments for the first
time in their reply brief. See, e.g., Bradley v. Vill. of Univ. Park,
59 F.4th 887, 897 (7th Cir. 2023); Laborers’ Pension Fund v. W.R.
Weis Co., Inc., 879 F.3d 760, 768 (7th Cir. 2018); Gonzales v.
Mize, 565 F.3d 373, 382 (7th Cir. 2009) (issues raised for the
first time in a reply brief are ordinarily waived). Because
Barnes failed to raise this issue in his opening brief, we find
he waived any claims that summary judgment was inappro-
priately granted to Dr. Aguinaldo.
Even if this argument was not waived, Barnes failed to
proffer evidence to create a genuine dispute of material fact
as to Dr. Aguinaldo’s care to survive summary judgment. In
essence, Barnes generally argues that he told several people—

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No. 24-2080 15
including Dr. Aguinaldo—about his hemorrhoids while he
was housed at Stateville, and no one helped him. Barnes con-
tends Dr. Aguinaldo’s testimony and Barnes’s medical rec-
ords show that Dr. Aguinaldo ignored Barnes’s complaints
and discounted the severity of Barnes’s condition.
At the same time, Barnes also asserts Dr. Aguinaldo pro-
vided “the most minimal treatment even after a specialist had
confirmed that Barnes need[ed] surgery and physical therapy
to enable him to benefit from such surgery.” “[A]n inmate is
not entitled to demand specific care, and medical profession-
als may choose from a range of acceptable courses based on
prevailing standards in the field.” Walker, 940 F.3d at 965 (ci-
tation modified). Barnes is not entitled to demand a specific
kind of care so long as it is established that he was cared for
within the range of acceptable treatment courses, and he con-
cedes that point.
Furthermore, Barnes has failed to put forth evidence
showing Dr. Aguinaldo knew of and disregarded an exces-
sive risk to his health. See Jackson, 105 F.4th at 961. Barnes saw
Dr. Aguinaldo three times: once in July 2016 for bleeding
hemorrhoids, once in October 2017 for strep throat, and once
in March 2018 for a shower permit renewal. Regarding the
July 2016 complaint, Dr. Aguinaldo performed a rectal exam-
ination and noted that Barnes was not in distress and found
no external hemorrhoids. Dr. Aguinaldo told Barnes to follow
up if needed. We see no evidence where Barnes followed up
concerning his hemorrhoids and Dr. Aguinaldo took no ac-
tion toward his treatment.
As for the October 2017 and March 2018 visits with
Dr. Aguinaldo, no evidence indicates that Barnes complained
of issues with his hemorrhoids during those visits. Out of the

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16 No. 24-2080
three times Dr. Aguinaldo met with Barnes, then, only once
did Barnes complain of hemorrhoids, and after examination,
Dr. Aguinaldo found no external hemorrhoids and instructed
Barnes to return if he had further issues. Since we defer to a
doctor’s medical judgment, unless it is so “outside the bounds
of medical professionalism,” an examination of Barnes’s rec-
tum, which revealed no external hemorrhoids, cannot sup-
port a showing of deliberate indifference by Dr. Aguinaldo.
See Walker, 940 F.3d at 965.
All said, even if this issue was not waived, we see no evi-
dence that Dr. Aguinaldo was deliberately indifferent to
Barnes’s hemorrhoids and that any treatment, or lack thereof,
caused Barnes a delay in treatment that aided in his suffering.
Thus, summary judgment was properly granted for Dr.
Aguinaldo on Barnes’s Eighth Amendment deliberate indif-
ference claim.
B. Monell Claim
Finally, Barnes asserts a Monell claim against Wexford al-
leging its collegial review process was the moving force of the
delayed treatment he received through the deliberately indif-
ferent actions of Dr. Obaisi and Dr. Aguinaldo.
Section 1983 provides a private right of action for prison-
ers seeking to enforce their Eighth Amendment rights against
corporations like Wexford. 42 U.S.C. § 1983. “Monell governs
Wexford’s liability in [Eighth Amendment deliberate indiffer-
ence cases] because we, like our sister circuits, treat private
corporations acting under color of state law as municipali-
ties.” Clemons, 106 F.4th at 638 (quoting Dean, 18 F.4th at 235).
So, for Barnes to prevail on such a claim requires evidence
that a Wexford policy, practice, or custom caused a

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No. 24-2080 17
constitutional violation. See Walker, 940 F.3d at 966 (citing
Whiting, 839 F.3d at 664). Barnes points to Wexford’s collegial
review policy as the “moving force” behind the delayed care
and recommendations of Dr. Obaisi and Dr. Aguinaldo—all
of which he claims violated his Eighth Amendment rights. See
Dean, 18 F.4th at 235 (citation omitted).
But when there is no finding of a constitutional violation,
Monell liability cannot attach to the private corporation the
claim is asserted against. City of Los Angeles v. Heller, 475 U.S.
796, 799 (1986) (per curiam) (recognizing that there can be no
Monell liability in the absence of an underlying constitutional
violation); Peoples v. Cook County, 128 F.4th 901, 905 (7th Cir.
2025) (“Absent a constitutional injury, there is no municipal
liability under Monell.”). That’s the case here.
Thus, because we found Barnes failed to support his
Eighth Amendment claims against Dr. Obaisi and Dr.
Aguinaldo and Barnes’s Monell claim against Wexford is
rooted in those claims, we also find that he has no viable Mo-
nell claim for liability to attach to Wexford.
III. CONCLUSION
Accordingly, we find that both Dr. Obaisi and Dr.
Aguinaldo were not deliberately indifferent to Barnes’s pro-
lapsed hemorrhoidal condition in violation of the Eighth
Amendment. And because there can be no Monell liability
without a constitutional violation, we AFFIRM.

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