United States District Court, N.D. Illinois, Eastern Division
FIRAS M. AYOUBI, Plaintiff,
CARLOS ALTEZ, et al., Defendants.
OPINION AND ORDER
CHARLES RONALD NORGLE Judge United States District Court
Ayoubi ("Plaintiff) sues physician assistant Carlos
Altez ("Altez"), Cook County Sheriff Thomas Dart
("Dart"), Chairwoman of the Department of
Correctional Health at Cermak Health Services of Cook County
("Cermak") Dr. Connie Mennella
('"Mennella"), and Cook County (collectively,
"Defendants") pursuant to 42 U.S.C. § 1983 for
deliberate indifference to Plaintiffs objectively serious
medical need. In particular, the claim against Altez is in
his individual capacity for treatment of Plaintiff s
condition allegedly in violation of Plaintiff s Fourteenth
Amendment rights; the claims against Dart and Mennella are in
their official capacities for alleged systemic deficiencies
at the Cook County Department of Corrections
("CCDOC") and Cermak; and Cook County remains in
this litigation for indemnification purposes only. Before the
Court is Defendants' motion for summary judgment. For the
following reasons, the motion is granted.
a thirty-one-year-old male, has been detained at the CCDOC
since December 2012. Altez served as a licensed physician
assistant at Cermak, Dart is the Cook County Sherriff, and
Mennella chaired the Department of Correctional Health at
Cermak. In roughly August 2013, Plaintiff developed a
one-centimeter lump beneath the areola of his left nipple. He
described the pain associated with the lump as an
uncomfortable prickling pain and burning feeling. At another
time, he characterized the pain as "like getting pricked
with a needle from the inside out." PL's Resp. to
Defs.' Statement of Facts ("PRDSOF") ¶ 4.
In other instances, Plaintiff described the pain as
discomfort. Deposition testimony shows that on some occasions
Plaintiff stated that his pain was constant and at other
times sporadic. It never in any way interfered with his daily
activity as an inmate.
January 15, 2014, Plaintiff received medical treatment for a
different health problem, but he did not notify the medical
provider about the lump. On February 1, 2014, Plaintiff
filled out a Health Service Request ("HSR") seeking
treatment for the painful lump. The HSR indicated increasing
pain and size. The next day, Plaintiff saw Nurse Elizabeth
Santos ("Santos") and asked for pain medication.
Santos declined to provide pain medication at this initial
appointment. Instead, Santos booked an appointment for
Plaintiff to see Altez on February 26, 2014. On February 13,
2014, Plaintiff completed another HSR in which he reiterated
his pain and stated that he had not received pain medication.
On February 15, 2014, later Santos gave Plaintiff twelve
200mg tablets of ibuprofen.
February 26, 2014, Plaintiff saw Altez regarding the lump.
Plaintiffs vitals were taken prior to seeing Altez. At the
appointment, Altez conducted a physical examination of
Plaintiffs chest, including the areola. Altez ultimately
diagnosed Plaintiff with gynecomastia. Gynecomastia is the
excessive growth of the male mammary glands, generally
associated with metabolic derangements that lead to estrogen
accumulation, testosterone deficiency, and
hyperprolactinemia. In some cases, gynecomastia may develop
to the stage at which milk is produced, commonly called
lactation. Although not as common in males in their twenties,
as Plaintiff was at the time of his February 26, 2014
diagnosis, the condition is relatively common among infants,
adolescents, and men over fifty.
treatment notes indicate that Plaintiff complained of sharp
and intermittent chest pain. Plaintiff alleges that Altez
made light of Plaintiff s condition by laughing while asking
whether Plaintiff was lactating and that he was embarrassed
as a result of Altez's asking such a question. Plaintiff
asked Altez for pain medication but claims that Altez
declined to provide the medication at that point. However,
Altez did prescribe the antibiotic clindamycin, which is used
to treat serious infections. Altez also ordered several blood
tests, including a complete blood count with differential to
test Plaintiffs blood cell and platelet count, a
follicle-stimulating hormone test to evaluate Plaintiffs
testicular function and spermatozoids production, and a
thyroid stimulate hormone test to determine if Plaintiff had
thyroid abnormalities. Additionally, Altez ordered an
ultrasound of Plaintiff s left breast and nipple, which took
place on March 4, 2014, six days later. The ultrasound was
used to confirm the gynecomastia diagnosis and to rule out
other (and potentially malignant) breast conditions such as
cancer or an abscess. Plaintiffs deposition also reflects
that he underwent a second ultrasound to check his other
breast. Plaintiff was scheduled for a follow-up appointment
on March 19, 2014. He was not treated with pain medication in
March 19, 2014 appointment, Altez discussed the ultrasound
results with Plaintiff. The results confirmed the
gynecomastia diagnosis. The test did not reveal any other
abnormalities. Plaintiff asserts that Altez made additional
embarrassing comments and again did not prescribe pain
medication. For example, Plaintiff claims that Altez stated
that Plaintiff could handle the condition because he is a
"big boy, " Id. at 63:10, that the
hospital was not "University of Chicago Hospital, "
PRDSOF, Ex. B, 63:21-64:1, and that Altez fist-bumped him,
presumably an alternative to a handshake. While the "big
boy" term should have been buttoned, that the prison
treatment center was not the "University of Chicago
Hospital" was starkly accurate. Ultimately, Plaintiff
alleges that the bases of his deliberate indifference claim
as to the March 19, 2014 visit are the aforementioned
comments and gestures by Altez and Altez's decision not
to prescribe the amount of medication Plaintiff desired.
informed Plaintiff that if the gynecomastia did not go away
on its own, Plaintiff could have a surgeon "cut it
off." Id. at 55:24-56:6. Liposuction and
mastectomies are treatment options when gynecomastia
persists. Plaintiff was later taken to a plastic surgeon at
Stroger Hospital for a consultation the regarding the
surgical removal of the growth on his areola. He informed the
plastic surgeon that he would consider the possibility.
Ultimately, Plaintiff declined the surgical removal of the
lump beneath the areola of his nipple because he "was
worried about the scar for cosmetic reasons."
Id. at 71:11-12. He was also concerned after the
plastic surgeon informed him about the risks attendant to
surgery, which is routine medical practice in order to obtain
informed consent from a patient.
to Altez's medical opinion, Plaintiff alleges that
gynecomastia is a serious condition. Plaintiff stated at his
deposition that his sources for this conclusion are articles
that his former cellmate provided to him. Plaintiff also
could not remember the authors of any of these articles. In
his deposition, however, Plaintiff acknowledges that the
gynecomastia did not limit him at all outside of experiencing
pain, embarrassment, and repeatedly visiting outside
declining surgery, on April 9, 2014, Plaintiff submitted
another HSR, claiming constant and severe pain and stating
that he had not received pain medication. In response,
Plaintiff was scheduled for an appointment with Nurse Lisa
Locke ("Locke"). Locke did not provide pain
medication. On April 30, 2014, however, Santos gave Plaintiff
another twelve 200mg tablets of ibuprofen, though Plaintiff
asserts that it was for an unrelated ailment. On June 3,
2014, Plaintiff was prescribed pain medication for his
gynecomastia. The record reflects that Altez took notes on
his computer "on every visit, " Id. at
56:20-21, in order to maintain computerized records of
Plaintiff s treatment.
was also able to purchase eight pain pills per week from the
CCDOC commissary for the duration of the treatment at issue.
The commissary sold two pills for about 45 cents. Plaintiff
stated in his deposition he accessed the commissary for these
pills ''regularly." Id. at 134:18.
Additionally, he acknowledged that "the pain medicine
the nurse was giving me, the Tylenols or Advil packs [were] .
. . several packs more than I'm allowed to buy on the
commissary. . ." Id. at 166:17-20.
Plaintiff received numerous tests, declined the surgical
removal of the growth on his areola, and consistently
received and purchased pain and other medication. That
notwithstanding, Plaintiff alleges that Altez was
deliberately indifferent because Altez failed to treat to
Plaintiffs pain and made light of Plaintiff s condition.
Plaintiff submitted his Complaint on June 9, 2014.
A. Standard of Review
judgment is appropriate when '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.'"
Northfield Ins. Co. v. City of Waukegan, 701 F.3d
1124, 1128 (7th Cir. 2012) (quoting Fed.R.Civ.P. 56(a)); see
also Celotex Corp. v. Catrett, 477 U.S. 317, 322
(1986). "A genuine issue of material fact exists when
the evidence is such that a reasonable jury could return a
verdict for the nonmoving party." Wells v.
Coker, 707 F.3d 756, 760 (7th Cir. 2013) (internal
quotation marks and citation omitted). "On summary
judgment a court may not make credibility determinations,
weigh the evidence, or decide which inferences to draw from
the facts; these are jobs for a factfinder." Payne
v. Pauley, 337 F.3d 767, 770 (7th Cir. 2003) (citing
Anderson v. LibertyLobby, Inc., 477 U.S.