Monell Policy Liability, Rehabilitation Act Pleading, and Prison Medical Care: Commentary on Akard v. Wexford of Indiana, LLC (7th Cir. 2025)

Note: The Seventh Circuit explicitly designates this as a “NONPRECEDENTIAL DISPOSITION,” to be cited only under FED. R. APP. P. 32.1. It does not create binding precedent, but it is still a useful illustration of how the court applies existing doctrine in prison medical-care and disability cases.

I. Introduction

This commentary examines the Seventh Circuit’s nonprecedential order in Jeffrey E. Akard v. Wexford of Indiana, LLC, et al., No. 25‑1636 (7th Cir. Dec. 22, 2025), affirming summary judgment and screening dismissals in a prisoner civil rights and Rehabilitation Act suit.

A. Parties and Institutions

Plaintiff-Appellant: Jeffrey E. Akard, an Indiana state prisoner.
Defendants-Appellees:
- Commissioner of the Indiana Department of Correction (“IDOC”), in official capacity (Rehabilitation Act claim).
- Mark Sevier, Superintendent of New Castle Correctional Facility (official capacity claims).
- Wexford of Indiana, LLC – private medical contractor for IDOC until July 2021.
- Centurion Health of Indiana, LLC – successor private medical contractor thereafter.

B. Factual Background

Akard was incarcerated at:

Wabash Valley Correctional Facility (2019–2020), then
New Castle Correctional Facility (2020 onward).

He has two key medical conditions:

Gastroesophageal reflux disease (GERD), and
Chronic back and shoulder pain.

His core complaints were that:

He was denied or restricted in access to GERD medications (particularly Omeprazole, a proton pump inhibitor).
He was denied a bottom-bunk pass despite chronic back/shoulder problems.
Prison policies interfered with his ability to prepare “GERD‑friendly” meals (access to microwave / hot water machine).
He did not receive certain disability accommodations: special mattress, lumbar roll, and job modifications.

C. Claims Raised

Akard brought multiple legal theories:

Eighth Amendment (via 42 U.S.C. § 1983) – deliberate indifference to serious medical needs:
- Against Wexford and Centurion under Monell-type “policy or custom” liability.
Fourteenth Amendment (via § 1983):
- Conditions of confinement – meal-preparation restrictions allegedly exacerbating GERD.
- Equal Protection – alleged disparity between care in state versus prior federal custody, and later alleged disparities between him and other inmates.
Rehabilitation Act of 1973, 29 U.S.C. § 794:
- Alleged failure to accommodate his disability (sleeping, self‑care, and work-related limitations).
- Brought against IDOC Commissioner (official capacity), Wexford, Centurion, and Sevier.

D. Procedural Posture

The district court screened the operative complaint under 28 U.S.C. § 1915A and dismissed:
- The Fourteenth Amendment equal protection claim for failure to plead differential treatment of similarly situated prisoners.
- The Rehabilitation Act claim against all defendants except the IDOC Commissioner (no personal liability; and no allegation that the private companies received federal funds).
The court allowed:
- Eighth Amendment–Monell claims against Wexford and Centurion (for medication and bottom-bunk policy/customs).
- A conditions-of-confinement claim against Sevier (official capacity) regarding access to meal preparation (eventually resolved by summary judgment, not appealed).
- A Rehabilitation Act claim against the IDOC Commissioner (official capacity), which ultimately settled after surviving summary judgment.
After discovery, the court granted summary judgment for Wexford and Centurion on the Eighth Amendment claims and for Sevier on his remaining claim. Only these rulings and the earlier screening dismissals were appealed.

II. Summary of the Seventh Circuit’s Disposition

A. Overview of the Holding

The Seventh Circuit, in a short nonprecedential order, affirmed:

Summary judgment for Wexford and Centurion on the Eighth Amendment policy-based deliberate indifference claims given:
- No underlying Eighth Amendment violation on the record.
- No evidence of a policy or custom showing conscious disregard of substantial risk to health.
Screening dismissals of:
- Rehabilitation Act claims against Wexford, Centurion, and Sevier (no personal liability; no allegation of federal funding for private providers).
- The equal protection claim (failure to plead comparator-based discrimination; and later “supplemental” allegations came too late).
Denial of motions to recruit counsel in the district court, finding the judge correctly applied the Pruitt v. Mote standard and did not abuse discretion.
Denied Akard’s renewed motion in the Seventh Circuit for counsel on appeal.

B. Key Factual Findings Underpinning the Result

GERD Medication:
- Wexford cancelled his prescription at one point due to nationwide supply shortages.
- Both Wexford and Centurion had policies restricting use of certain GERD drugs (like Omeprazole) based on concerns about long-term side effects and medical guidelines.
- Staff instructed Akard to obtain over-the-counter (OTC) medication from the commissary; Akard admitted in discovery that he had “never gone without” some form of medication and could obtain it from commissary or other sources.
Bottom-bunk Pass:
- Policies reserved bottom-bunk assignments for specific conditions.
- A Wexford physician evaluated Akard and found he did not meet the criteria.
- Policies allowed doctors to request exceptions; none was requested for him.
- After Centurion took over in 2021, Akard did not renew his request for a bottom-bunk pass.
Disability Accommodations under the Rehabilitation Act:
- The only RA claim left in district court was against the Commissioner in official capacity; it survived summary judgment and later settled.
- Claims against Wexford, Centurion, and Sevier were dismissed at screening for legal deficiencies in the pleadings.

III. Analysis of the Opinion

A. Precedents and Authorities Cited

1. Monell v. Department of Social Services, 436 U.S. 658 (1978)

Monell holds that municipalities (and, under Seventh Circuit doctrine, private entities acting under color of state law) are:

Not vicariously liable under § 1983 for employees’ actions under respondeat superior.
Liable only when a constitutional violation is caused by an official policy, practice, or custom, or by a decision of a final policymaker.

The district court and the Seventh Circuit both treated Wexford and Centurion as Monell-type defendants. The claims could proceed only if:

There was an underlying constitutional violation (here, deliberate indifference under the Eighth Amendment), and
A policy, practice, or custom of Wexford/Centurion was the “moving force” behind that violation.

The Seventh Circuit explicitly applies the “no underlying violation, no Monell liability” principle by citing Gaetjens, discussed next.

2. Gaetjens v. City of Loves Park, 4 F.4th 487 (7th Cir. 2021)

Gaetjens reinforces that Monell liability requires a constitutional violation. If the evidence does not support any constitutional violation, there is nothing for a policy or custom to cause, and the Monell claim fails as a matter of law.

Here, even assuming the existence of medication- and bunk-related policies, the court held that the record did not allow a reasonable jury to find deliberate indifference under the Eighth Amendment. Accordingly, Gaetjens made it straightforward to affirm summary judgment on the policy-based claims.

3. Farmer v. Brennan, 511 U.S. 825 (1994)

Farmer is the foundational Eighth Amendment deliberate-indifference case. It requires proof of:

Objective component – a serious medical need or substantial risk of serious harm; and
Subjective component – the official actually knew of and consciously disregarded that risk.

The court applied the subjective prong to the corporate policies themselves: Akard had to show that Wexford and Centurion’s decision-makers knew their Omeprazole limits and bunk policies would create a substantial risk of serious harm and nevertheless maintained them.

The Seventh Circuit concluded:

Omeprazole policy was motivated by medical concerns regarding long-term side effects, not cost-cutting indifference.
Bottom-bunk policy was administered through individualized medical judgment (physician evaluation) with discretion for exceptions.
No evidence showed corporate-level conscious disregard of a known, substantial risk to Akard.

4. Dean v. Wexford Health Sources, Inc., 18 F.4th 214 (7th Cir. 2021)

Dean is another major Seventh Circuit case on Monell liability for private prison medical contractors. It stresses that:

Showing isolated incidents or personal disagreement with treatment does not establish a corporate policy/custom causing constitutional violations.
A plaintiff must demonstrate a pattern or practice or other policy decision that predictably leads to constitutional harm.

The Seventh Circuit invoked Dean to reject Akard’s argument that occasional unavailability of certain medications or limits on OTC purchases equated to a dangerous policy or custom. The court found no recurring pattern of untreated GERD or corporate knowledge of systemic harm.

5. Clemons v. Wexford Health Sources, Inc., 106 F.4th 628 (7th Cir. 2024)

Clemons illustrates how the court evaluates bottom-bunk and housing assignments in Eighth Amendment claims. It typically examines:

Whether medical staff exercised professional judgment.
Whether the denial was so far outside accepted medical standards that it suggests deliberate indifference rather than mere negligence or disagreement.

Here, the court pointed to Clemons in observing that a Wexford physician examined Akard and determined that he did not meet the criteria for a bottom-bunk pass. That evaluation—combined with the possibility of doctor-requested exceptions—supported a finding of medical judgment, not deliberate indifference.

6. Thomas v. Blackard, 2 F.4th 716 (7th Cir. 2021)

Thomas is cited for the familiar summary-judgment standard:

The court views the evidence in the light most favorable to the nonmoving party (here, Akard).
Summary judgment is appropriate only where no reasonable jury could find for the nonmovant.

The panel explicitly acknowledges it views the record in Akard’s favor, then concludes that—even under that favorable view—his evidence is legally insufficient to sustain his claims.

7. Rehabilitation Act and Equal Protection Cases

Shaw v. Kemper, 52 F.4th 331 (7th Cir. 2022):
- Reiterates that under the Rehabilitation Act (“RA”), a plaintiff must be denied access to a service, program, or activity solely by reason of disability.
Stanek v. St. Charles Cmty. Unit Sch. Dist. No. 303, 783 F.3d 634 (7th Cir. 2015):
- Holds there is no personal liability under the RA (and, by analogy, under Title II of the ADA). Claims must run against the public entity or appropriate official-capacity defendant, not individual officers or employees.
Jaros v. Illinois Dep’t of Corrections, 684 F.3d 667 (7th Cir. 2012):
- Clarifies that the RA applies only to “programs or activities receiving Federal financial assistance.”
- Private or state actors not receiving federal funds are not proper RA defendants.
- Also a key prison RA/ADA case on access to meals, showers, and beds as “programs or activities.”
Vexol, S.A. de C.V. v. Berry Plastics Corp., 882 F.3d 633 (7th Cir. 2018):
- Approves district courts giving a plaintiff a clear, “last chance” to amend a complaint and then holding the plaintiff to that deadline instead of entertaining serial supplementation.

These precedents drive the court’s affirmance of the RA screening dismissals and its refusal to allow Akard to resurrect his equal protection theory via late-added factual allegations.

8. Appointment of Counsel – Pruitt v. Mote, 503 F.3d 647 (7th Cir. 2007) (en banc)

Under Pruitt, a district court assessing a prisoner’s motion for counsel must:

Determine whether the plaintiff made a reasonable attempt to obtain counsel on his own or was effectively precluded from doing so.
Evaluate, in light of the case’s difficulty and the plaintiff’s competence, whether counsel is necessary to ensure a fair presentation.

The Seventh Circuit held the district court properly applied this two-step test each time it denied counsel. It emphasized that:

Akard’s filings were clear and well-organized.
The issues (at the relevant stages) were not so complex as to exceed his demonstrated abilities.
Later, when the RA claim against the Commissioner survived summary judgment, the district court sua sponte reconsidered and appointed counsel, confirming that the court was attentive to changing circumstances.

B. The Court’s Legal Reasoning

1. Eighth Amendment Claims: GERD Medication Policy

a. Claim Theory

Akard’s theory was not that individual doctors were negligent or mean-spirited; he framed his Eighth Amendment challenge as a policy-based Monell claim. He argued that:

Wexford and Centurion had policies restricting prescriptions of certain GERD medications, especially Omeprazole.
These policies, together with commissary limitations (daily OTC purchase caps, intermittent unavailability), posed a substantial risk to his health.
The providers allegedly knew or should have known about this risk and yet maintained the policies.

b. Court’s Evaluation

The court treated the claim as requiring proof that corporate policymakers:

Were aware of a substantial risk of serious harm to GERD patients like Akard from their policies, and
Consciously disregarded that risk (Farmer standard).

The Seventh Circuit highlighted several key facts:

The policy restricting Omeprazole was based on emerging medical research and concerns about long-term side effects, not simply cost-savings.
The policy did not leave Akard entirely untreated:
- He admitted he could secure alternative OTC remedies (e.g., antacids) from the commissary.
- He testified he had “never gone without” medication for his GERD.
Any periods of intermittent unavailability of OTC medications or difficulties in acquiring them (including from other inmates at higher prices) did not amount to:
- A pattern or custom of leaving GERD untreated across the facility, or
- Evidence that Wexford or Centurion knew of such a pattern and ignored it.

Thus, the court concluded:

No underlying Eighth Amendment violation was supported by the evidence.
Given the absence of a constitutional violation, Monell liability fails as a matter of law under Gaetjens.

2. Eighth Amendment Claims: Bottom-Bunk Pass Policy

a. Claim Theory

Akard alleged that the bunk-assignment policies of Wexford and Centurion—tied to corporate criteria for bottom bunks—unconstitutionally denied him necessary accommodation for chronic back and shoulder pain. He characterized these as:

Policies that “minimized” his disability and
Reflected corporate indifference to the serious risk of injury or pain from climbing to a top bunk.

b. Court’s Evaluation

The court again focused on the subjective Farmer standard and emphasized:

Akard was examined by a Wexford physician who exercised medical judgment and concluded he did not meet bottom-bunk criteria.
The policy allowed physicians to request exceptions to the criteria; the existence of this discretion undermines a claim that the policy was rigidly indifferent.
Akard never renewed his bottom-bunk request after Centurion assumed care, weakening any argument that Centurion knowingly maintained a harmful status quo.

In light of Clemons, the court treated this as a dispute about the adequacy of medical judgment rather than a corporate-level policy of ignoring known risk. Without evidence that Wexford or Centurion knew that adherence to their criteria was placing Akard at a substantial risk (and disregarded that), the deliberate indifference element could not be satisfied.

Again, no underlying Eighth Amendment violation means the Monell claim could not proceed.

3. Rehabilitation Act Claims at Screening

a. Elements and Proper Defendants

To state a claim under the Rehabilitation Act in this context, Akard had to plausibly allege:

He is a person with a disability.
He was denied access to a program, service, or activity or subjected to discrimination.
The denial occurred solely by reason of his disability. (29 U.S.C. § 794(a); Shaw.)
The relevant entity is a “program or activity receiving Federal financial assistance.” (Jaros.)

Additionally, under Stanek:

There is no personal-capacity liability for individuals (like Sevier) under the RA.
Claims must be against the public entity itself or an official in his official capacity.

b. Application in This Case

Claim against Sevier:
- Dismissed because there is no personal liability under the RA. Suing Sevier personally was legally defective.
Claims against Wexford and Centurion:
- Dismissed because Akard’s complaint failed to allege that these private companies received federal funding.
- Without such an allegation, they are not “programs or activities receiving Federal financial assistance,” and thus not RA defendants under Jaros.
Claim against the Commissioner (official capacity):
- Survived summary judgment at the district court level because there were factual disputes on whether Akard was denied reasonable accommodations (related to sleep, self-care, and work).
- Later settled, leaving the appellate court to consider only the screening dismissals as to other RA defendants.

The Seventh Circuit explicitly affirms the screening dismissals as a straightforward application of Stanek and Jaros.

4. Equal Protection Claim and Late Supplementation

a. Initial Pleading Defect

Equal protection claims require, at a minimum:

Allegations that the plaintiff was treated differently from similarly situated individuals, and
That this disparate treatment was not justified by a legitimate governmental interest (or was irrational, or motivated by impermissible discrimination).

Initially, Akard argued he received worse treatment in state custody than when he was in federal custody. The district court correctly dismissed this because:

Prisoners in different systems (state vs. federal) are not typically “similarly situated” for equal protection purposes.
The claim did not identify any comparable state prisoners treated more favorably.

b. Attempted Late Supplementation

Akard later tried to supplement his allegations to say that similarly situated state prisoners:

Were prescribed GERD medications, and
Received accommodations for meal preparation.

But the district court had previously:

Expressly warned Akard that his second amended complaint was his last opportunity to include all relevant facts, and
Alerted him that failure to do so could result in dismissal and refusal to entertain piecemeal additions (Vexol rationale).

The Seventh Circuit held the district court was within its discretion in:

Refusing to treat post-screening materials as amending the complaint, and
Relying on the operative complaint as pleaded at the time of screening.

Therefore, the equal protection claim remained deficient, and its dismissal was affirmed.

5. Denial of Motions to Recruit Counsel

Applying Pruitt, the Seventh Circuit examined whether:

Akard had attempted to secure counsel on his own (he had).
The case’s complexity and his capacity warranted appointed counsel.

The record showed that:

Akard’s written submissions were coherent, organized, and legally literate.
The legal questions during discovery and early summary judgment (Eighth Amendment and pleading sufficiency) were not so complex as to exceed his demonstrated abilities.
When the RA claim against the Commissioner survived summary judgment—a stage where factual development and legal complexity increased—the district court revisited the issue on its own and granted counsel.

The Seventh Circuit thus concluded there was no abuse of discretion in the earlier denials, and it similarly declined to appoint counsel for appeal.

C. Impact and Significance

1. Practical Lessons for § 1983 Prison Medical Claims

Monell claims against private prison medical vendors remain demanding.
- Plaintiffs must identify a specific policy or widespread practice and connect it causally to a proven constitutional violation.
- Merely disagreeing with particular medical decisions, or pointing to occasional shortages or inconveniences, is not enough.
Medical judgment vs. deliberate indifference.
- Policies grounded in medical research and known side-effect profiles (e.g., limiting long-term PPI use) are hard to recast as deliberate indifference.
- Courts are reluctant to constitutionalize disagreements over which reasonable treatment is best, absent evidence that the treatment is “so blatantly inappropriate” as to reflect conscious disregard.
Reliance on commissary access is not automatically unconstitutional.
- Where a prisoner actually has continuous access to some form of effective treatment (even if at personal cost), courts may deem the medical need addressed.
- However, future cases might distinguish situations where indigent prisoners genuinely cannot afford commissary medication or where commissary supply disruptions are pervasive and known.

2. Clarifications for Rehabilitation Act Prison Litigation

Proper defendants must be pled from the start.
- Individual officers or wardens are not RA defendants in their personal capacities (Stanek).
- Private contractors must be alleged to receive federal funding to be sued under the RA (Jaros).
Programs, services, or activities vs. quality of care.
- The RA is not a general quality-of-care statute; it targets disability-based exclusion from benefits and services.
- Here, the surviving RA claim (against the Commissioner) focused on accommodations related to sleep, self-care, and work—classic “programs or activities” in the prison context.

3. Equal Protection and Pleading Discipline

Comparator pleading is essential.
- Prisoners challenging disparate treatment must identify plausible comparators (similarly situated inmates) treated more favorably.
- Comparing state custody to prior federal custody is generally not sufficient.
Court-imposed amendment deadlines matter.
- Where a court clearly states that a particular amended complaint is the plaintiff’s final opportunity to plead all relevant facts, late “supplements” are not guaranteed consideration.
- Vexol confirms district courts’ authority to manage pleadings and enforce such final deadlines.

4. Appointment of Counsel in Prison Cases

Pruitt remains the governing standard.
- Courts must consider both the prisoner’s efforts to obtain counsel and his capacity to litigate relative to case complexity.
District courts may revisit counsel decisions.
- Akard’s case shows a pragmatic approach: counsel was denied when issues were straightforward and filings competent, but granted later when a claim survived summary judgment and became more complex.

Because the disposition is nonprecedential, it will not bind future panels, but it is a useful data point for how the Seventh Circuit currently:

Frames the line between policy-based deliberate indifference and permissible medical judgment;
Demands technical compliance in RA pleading; and
Enforces procedural discipline in amended complaints and counsel motions.

IV. Complex Concepts Simplified

A. “Deliberate Indifference” under the Eighth Amendment

In prison medical cases, “deliberate indifference” means more than malpractice or bad outcomes. It requires:

Serious medical need: a condition that a doctor says needs treatment or that is so obvious even a layperson would recognize the need.
Conscious disregard: officials know about a substantial risk of serious harm and choose to ignore it.

Examples of deliberate indifference might include:

Refusing to provide any treatment for a serious chronic disease.
Delaying urgently needed treatment for non-medical reasons.
Persisting in obviously ineffective treatment that any reasonable doctor would know is useless and dangerous.

But:

Choosing one reasonable treatment over another (e.g., OTC medications instead of prescription Omeprazole) usually reflects medical judgment.
Errors in judgment or negligence alone, without conscious disregard of known risk, are not constitutional violations.

B. “Monell” Policy or Custom Liability

Under Monell, you cannot sue a city—or a private contractor like Wexford or Centurion—for every misdeed of its employees. Instead, to hold the entity liable, you must show:

Underlying constitutional violation – some right, like the Eighth Amendment, was actually violated.
Policy, practice, or custom – the entity had:
- Official rules, or
- A widespread pattern of conduct, or
- Actions by a high-level decisionmaker
that led to the violation.
Causation – the policy was the reason the violation occurred.

In Akard, because the court saw no underlying Eighth Amendment violation, the policies could not create Monell liability.

C. Rehabilitation Act Basics

The Rehabilitation Act (RA) is a federal anti-discrimination statute for people with disabilities. In prison, it can apply when:

The plaintiff has a qualifying disability.
The prison or its programs receive federal funding.
The plaintiff is excluded from or denied the benefits of a service, program, or activity solely because of disability.

Important nuances:

You usually cannot sue individual employees personally under the RA; you sue the public entity (e.g., Department of Correction) or an appropriate official in his official capacity.
A plaintiff must allege that the entity (or private contractor) receives federal funds to invoke the RA.

D. Screening under 28 U.S.C. § 1915A

Section 1915A requires courts to review prisoner complaints early and dismiss:

Frivolous or malicious claims,
Claims that fail to state a claim on which relief can be granted, or
Claims against immune defendants.

The court reads the complaint generously, but it still must contain enough facts to state a plausible legal claim. In Akard, the RA and equal protection claims fell at this stage due to legal and factual shortcomings in the pleadings.

E. “Nonprecedential Disposition” and Fed. R. App. P. 32.1

A nonprecedential disposition:

Is not binding precedent on future panels.
May still be cited as persuasive authority under Federal Rule of Appellate Procedure 32.1, subject to each circuit’s rules.

So while Akard does not change the law in the formal sense, it shows how the Seventh Circuit applies existing rules in similar cases.

F. Appointment of Counsel in Civil Cases (Pruitt Standard)

Unlike criminal cases, civil litigants (including prisoners) do not have a constitutional right to counsel. Courts may “recruit” counsel in appropriate cases after weighing:

Whether the plaintiff tried to obtain counsel independently, and
Whether, considering the complexity of the case and the plaintiff’s abilities (education, literacy, litigation experience, mental health, etc.), counsel is necessary for a fair process.

In Akard, the court concluded that he was competent to litigate most aspects of his case on his own, but counsel was later appointed when the remaining RA claim became more complex.

V. Conclusion

Akard v. Wexford of Indiana, LLC is a concise but instructive nonprecedential decision illustrating the Seventh Circuit’s current approach to:

Eighth Amendment medical-care claims against private prison healthcare providers, reaffirming that:
- Policy restrictions grounded in medical judgment (e.g., on long-term PPI use) rarely constitute deliberate indifference.
- Access to some form of effective treatment, even via commissary, can defeat claims that medical needs were ignored.
- Monell liability requires both a constitutional violation and a causative policy or custom.
Rehabilitation Act pleading, emphasizing:
- No personal liability for individual officials.
- The necessity of pleading federal funding for private contractors.
Equal Protection pleading discipline, underscoring:
- The need for concrete comparators.
- Court authority to limit iterative amendments and disregard late-added facts after a “final chance” warning.
Appointment of counsel under Pruitt, showing:
- Careful, stage-specific evaluation of the prisoner’s competence and case complexity.
- Willingness to appoint counsel once a claim survives to a more demanding phase (here, the RA claim against the Commissioner).

Although it does not create binding precedent, Akard serves as a practical guide for prisoners, counsel, and courts on how to structure and evaluate Eighth Amendment, Rehabilitation Act, and equal protection claims involving prison medical care and accommodations—and on the evidentiary and pleading burdens that such claims must meet in the Seventh Circuit.