In the

    United States Court of Appeals
                 For the Seventh Circuit
                      ____________________
No. 20-2946
ROBERT MCDANIEL, as Executor of
the Estate of Carl Joseph McDaniel,
                                               Plaintiff-Appellant,

                                v.

SALAM SYED, et al.,
                                            Defendants-Appellees.
                      ____________________

        Appeal from the United States District Court for the
                    Eastern District of Wisconsin.
       No. 1:17-cv-01493-WCG — William C. Griesbach, Judge.
                      ____________________

  ARGUED JANUARY 13, 2022 — DECIDED SEPTEMBER 16, 2024
                ____________________

   Before HAMILTON, BRENNAN, and JACKSON-AKIWUMI,
Circuit Judges.
    HAMILTON, Circuit Judge. Carl McDaniel was a Wisconsin
prisoner for more than fourteen years. He had many serious
medical conditions, including some that caused problems
with mobility and incontinence. McDaniel sued the Wiscon-
sin Department of Corrections under Title II of the Americans
with Disabilities Act (ADA), 

, and Section 504
2                                                         No. 20-2946

of the Rehabilitation Act, 

. He asserted that the
Department violated his rights under both statutes by deny-
ing him a cell (a) in a no-stairs unit, (b) that was single-occu-
pancy, and (c) with a bed without a top bunk above it.
McDaniel also brought an Eighth Amendment claim against
a prison physician, Dr. Salam Syed, alleging he was deliber-
ately indifferent to McDaniel’s medical needs. The district
court granted summary judgment for the Department on all
claims and for Dr. Syed on the Eighth Amendment claim.
McDaniel appealed. 1
    After we heard oral argument, McDaniel was released
from prison, but he later died, in February 2024. His son Rob-
ert McDaniel represents his father’s estate and is now the
plaintiff.
    We affirm in part and reverse in part. We affirm summary
judgment for defendants on the claims for a single-occupancy
cell and no top bunk, as well as on the Eighth Amendment
claim against Dr. Syed. We reverse on the refusal to assign
McDaniel to a no-stairs unit. McDaniel presented evidence
that having to make his way up and down stairs to get to
meals, the infirmary, and other prison programs effectively
denied him access to those programs, and that the Depart-
ment knew its refusal to place McDaniel in a no-stairs unit
was having that effect. In particular, McDaniel presented evi-
dence that denial of a no-stairs unit caused him to miss about
600 meals in just the one year he was in the Columbia

    1 After plaintiff McDaniel appealed the grant of summary judgment,

we recruited counsel for him. Attorneys Thomas G. Hungar and Andrew
G.I. Kilberg and the firm of Gibson, Dunn & Crutcher LLP have ably
represented plaintiff McDaniel before the panel. They have the thanks of
the court.
No. 20-2946                                                    3

Correctional Institution, and that prison staff knew he was
missing meals and medication because of his pain and diffi-
culty in getting up and down stairs. He presented this evi-
dence with sufficient clarity to the district court so that the
district court and we are required to treat those facts as true.
On these facts, which we hope are unusual, a reasonable jury
could find that the denial of a no-stairs unit amounted to an
intentional violation of rights under the ADA and the Reha-
bilitation Act.
    McDaniel’s release from prison rendered moot his request
for injunctive relief, but his ADA and Rehabilitation Act
claims for compensatory damages survive his release from
prison and his death and are still available. A jury could find
prison officials were deliberately indifferent to McDaniel’s
lack of access to various prison programs. Because a jury
could also find this same conduct—deliberate indifference to
McDaniel’s inability to access, in particular, regular meals—
violated the Eighth Amendment, the Department is not enti-
tled to sovereign immunity, and compensatory damages may
be available under the ADA for failure to accommodate his
disabilities.
I. Procedural Issue
   Before turning to the merits, we first address a key proce-
dural issue in the district court’s handling of the facts on sum-
mary judgment. The district court declined to treat as true
McDaniel’s evidence that the defendants’ refusal to assign
him to a no-stairs cell caused him to miss roughly 600 meals
in one year and that defendants were aware of this conse-
quence. The district court’s refusal was an error.
4                                                   No. 20-2946

    McDaniel litigated in the district court pro se, including
the summary judgment motions. (There was a brief exception;
court-recruited counsel drafted his amended complaints and
then withdrew.) As part of the summary judgment proceed-
ings, the defendants filed their proposed findings of fact sub-
ject to Civil Local Rule 56 of the Eastern District of Wisconsin.
In the absence of an agreed statement of undisputed facts, the
rule requires the moving party to file a statement of proposed
material facts. See E.D. Wis. Civ. Local Rule 56(b)(1). These
statements must contain numbered paragraphs and specific
citations to support the factual assertions. Local Rule
56(b)(1)(c)(i). The opposing party is then required to respond
to the moving party’s statement of material facts by identify-
ing which facts, if any, are in dispute, and citing record evi-
dence to support the party’s assertions. Local Rule 56(b)(2).
The rule says the record citations must be “specific” but does
not specify a particular form for those record citations.
   Consistent with our decision in Lewis v. Faulkner, 

 (7th Cir. 1982), the district court promptly issued a
notice to McDaniel advising him as follows:
       Plaintiff Carl Joseph McDaniel, who is repre-
       senting himself, filed a complaint under 

. On June 29, 2020, the defendants
       filed a motion for summary judgment. (ECF No.
       159.) Under Civil L. R. 56(b)(2), McDaniel’s re-
       sponse materials are due within thirty days of
       service of the motion, or by Wednesday, July 29,
       2020. In responding to the defendants’ motion
       for summary judgment, McDaniel must re-
       spond to each of the defendants’ proposed find-
       ings of fact by agreeing with each proposed fact
No. 20-2946                                                   5

      or explaining why he disagrees with a particu-
      lar proposed fact. If he does not indicate one
      way or the other, the court will assume that he
      agrees with the proposed fact. McDaniel must
      support every disagreement with a proposed
      fact by citing to evidence. He can do that by re-
      lying on documents that he attaches to his re-
      sponse or by telling the court his version of what
      happened in an affidavit or an unsworn decla-
      ration under 

 An unsworn dec-
      laration is a way for a party to tell his side of the
      story while declaring to the court that every-
      thing in the declaration is true and correct.
      McDaniel must also respond to the legal argu-
      ments in the defendants’ brief.
      _______________
      1
        At the bottom of his declaration he should
      state: “I declare under penalty of perjury that
      the foregoing is true and correct. Executed on
      [date]. [Signature].” 

(2).
Dkt. No. 169.
    McDaniel took the court’s notice to heart. On August 14,
2020, he filed seven documents (docket entries 176–82), in-
cluding a response to the defendants’ proposed findings of
fact, a brief, a separate “reply to defense argument,” and re-
sponses to four affidavits submitted by the defendants. The
documents totaled 33 pages.
    Plaintiffs’ documents responded paragraph by paragraph
to the defendants’ proposed statements of fact, and even par-
agraph by paragraph to each affidavit the defendants
6                                                    No. 20-2946

submitted and paragraph by paragraph to the defendants’
brief. He also submitted his own statements of undisputed
and disputed facts.
    In most of his response paragraphs, however, McDaniel
did not provide specific docket number citations to the record.
Still, he did in places refer by name to various documents in
the record when directly responding to paragraphs in the de-
fendants’ summary judgment briefing that included such rec-
ord citations. For example, he referred to “the ‘Initial’ Dr. Paul
Order” for the proposition that his surgeon recommended he
not lift more than five to ten pounds. This was in his num-
bered response to paragraph 11 of defendants’ proposed
statement of facts, which included a record citation to the
same doctor’s report that McDaniel cited by name.
    Most important, though, and consistent with the district
court’s directions, McDaniel signed all of those documents
under penalty of perjury under 

. That meant
that all of those documents had the legal effect of affidavits.
They provided evidence that could be considered on sum-
mary judgment to the extent that McDaniel’s factual asser-
tions were within his personal knowledge and were otherwise
admissible. See Owens v. Hinsley, 

 (7th Cir.
2011) (“[A] declaration under § 1746 is equivalent to an affi-
davit for purposes of summary judgment.”); Ford v. Wilson, 

, 246–47 (7th Cir. 1996) (complaint verified under pen-
alty of perjury amounted to affidavit that could be relied upon
to oppose summary judgment).
    In its summary judgment ruling, however, the district
court wrote that “not all of his responses or his own proposed
findings of fact cite to an affidavit, declaration, or specific part
of the record to support them.” SA 4. The court added that it
No. 20-2946                                                                 7

would consider plaintiff’s proposed facts and responses to de-
fendants’ proposed facts only “to the extent they comply with
the local rules,” without specifying further the failures or the
affected portions of plaintiff’s submissions. 

 The court re-
lied primarily on the defendants’ version of the facts in decid-
ing the summary judgment motions. 2
     McDaniel contends this decision was an abuse of discre-
tion. An appellate court reviews the decision of a district court
to enforce its local rules for an abuse of discretion. Hinterberger
v. City of Indianapolis, 

 (7th Cir. 2020). District
courts “may require strict compliance with their local rules,”

 and we have held that enforcing such rules in the event of
non-compliance is generally not an abuse of discretion. See
Cichon v. Exelon Generation Co., 

, 809–10 (7th Cir.
2005) (“A district court does not abuse its discretion when, in
imposing a penalty for a litigant’s non-compliance with Local
Rule 56.1, the court chooses to ignore and not consider the ad-
ditional facts that a litigant has proposed.”); see also Ammons
v. Aramark Uniform Services, Inc., 

 (7th Cir.
2004) (“Substantial compliance is not strict compliance.”). A
district court is not authorized, however, to reject a party’s
summary judgment submissions for failure to comply with
unwritten requirements.



    2 McDaniel did not, as Local Rule 56.1(b)(2)(B)(i) requires, reproduce

each numbered paragraph in the defendants’ statement of facts. That re-
quirement would be onerous as applied to a prisoner who has only limited
access to a defective typewriter, and the district court does not appear to
have relied on that failing. See also Fed. R. Civ. P. 83 (a)(2) (“A local rule
imposing a requirement of form must not be enforced in a way that causes
a party to lose any right because of a nonwillful failure to comply.”).
8                                                    No. 20-2946

    This is one of the rare cases in which the district court went
a step too far, at least with respect to one key fact. In his re-
sponse to the defendants’ proposed findings of fact, McDaniel
testified that he was “missing [h]undreds of state meals” at
the Columbia Correctional Institution. In his response to de-
fendant Dr. Syed’s affidavit, McDaniel said the prison “de-
nied [me] over 600 state meals.” His brief echoed these points,
saying that he “missed over 600 state meals in less than a year
because of severe pain,” and “Defendants were all aware of
the ongoing constitutional violations of the [o]ver 600 … state
meals.” Defendants’ own summary judgment submissions
also show that they were aware of plaintiff’s complaints that
he was missing many meals and medications because of pain
and difficulty getting up and down stairs. See Def. Proposed
Findings of Fact ¶¶ 30 36, 38, 39, Dkt. No. 167.
    Local Rule 56.1 did not require plaintiff to cite other affi-
davits in his affidavits. This seems to be the principal point of
our disagreement with the district court and with our dissent-
ing colleague. Where the moving party asserts as an undis-
puted fact “X is the case,” and plaintiff responds in the corre-
sponding paragraph “X is not the case,” and where the plain-
tiff’s response is attested under § 1746 and within his personal
knowledge, that is enough to dispute whether X is true or
false. See Owens, 

; Ford, 90 F.3d at 246–47 (7th
Cir. 1996). Moreover, defendants’ summary judgment papers
did not even try to contradict directly plaintiff’s complaints
about missing meals and medications because of his pain and
difficulty with stairs. We are required to treat as true
No. 20-2946                                                               9

plaintiff’s factual assertions that were supported with evi-
dence, including his own affidavits. 3
    It is evident that McDaniel, a pro se litigant, tried to com-
ply with the district court’s instructions. See Nichols v. Michi-
gan City Plant Planning Dep’t, 

 (7th Cir. 2014)
(“[A] trial court is obligated to give a liberal construction to a
pro se plaintiff’s filings.”). We know well that rules like Local
Rule 56 are intended “to make the summary judgment pro-
cess less burdensome on district courts, by requiring the par-
ties to nail down the relevant facts and the way they propose
to support them.” Sojka v. Bovis Lend Lease, Inc., 

 (7th Cir. 2012) (evaluating parallel local rule from another
district). That process can help a busy district court determine
which facts are supported by the record and which are not. It
also gives the court and the opposing party notice of which
legal and factual issues are up for debate. At the same time,
we have also explained that local rules—and instructions on
how to comply with them—are “not intended to provide a
maze of technical traps to complicate and delay litigation
without advancing the merits.” Stevo v. Frasor, 

 (7th Cir. 2011) (district court did not abuse discretion by
overlooking moving parties’ technical failures to comply with
local rule on summary judgment materials). Unfortunately,

    3 McDaniel was not consistent about how many hundreds of meals he

missed. In the amended complaint, he said the number was approxi-
mately 500. In his testimony submitted on summary judgment, that num-
ber was over 600. In one place in his brief in opposition to summary judg-
ment, he said an individual employee knew he missed over 450 meals,
again citing by name exhibits attached to that official’s declaration in the
record. The difference between 450 and 600 meals was not the basis for the
district court’s rejection of evidence that McDaniel missed hundreds of
meals.
10                                                 No. 20-2946

that is what occurred here, primarily because the district court
may not have appreciated that plaintiff could rely on his own
factual assertions in his own declarations without citing any
other documents.
    One could criticize plaintiff for not having organized his
summary judgment submissions as coherently and persua-
sively as an experienced lawyer might have. That does not
justify overlooking, however, plaintiff’s specific factual asser-
tions made under penalty of perjury. Even for excellent law-
yers, it can be difficult to provide a clearly organized response
to a motion for summary judgment. Local rules like this one
allow the moving party to organize the facts and the narra-
tive. The non-moving party is required to follow that organi-
zation, at least with respect to proposed facts. That can make
it difficult for a non-moving party with a solid case to weave
the evidence into a coherent narrative and to show how dif-
ferent facts and theories are related. For pro se parties, the
challenge can be especially daunting. In this case, however,
we conclude that McDaniel’s 33 pages of summary judgment
submissions told the district court with sufficient clarity that
he was relying on his own testimony about missing hundreds
of meals and medications, and about defendants’ awareness
of that consequence of his pain and mobility limits. And he
made that point in the portion of his brief addressing his ADA
and Rehabilitation Act claims. See Dkt. No. 177 at 10.
    To be sure, McDaniel’s submissions were not “by any
measure ideal.” Sojka, 

. Many of his supposed
facts were conclusory and argumentative. That is also often
true of submissions by counsel, of course, and a district court
is entitled to disregard such conclusory assertions even if a
party tries to ground them in record citations. Cichon, 401 F.3d
No. 20-2946                                                  11

at 808, 809–10 (no abuse of discretion in disregarding conclu-
sory submissions that lacked factual support). But the fact
that some proposed facts are conclusory or argumentative
does not mean a court is free to disregard the ones that are
factual and specific. See Fed. R. Civ. P. 56(e) advisory commit-
tee’s note to 2010 amendment (“If there is a proper response
or reply as to some facts, the court cannot grant summary
judgment without determining whether those facts can be
genuinely disputed.”).
    We conclude the district court abused its discretion in dis-
regarding McDaniel’s factual assertion sworn under penalty
of perjury that he had missed approximately 600 meals in one
year at Columbia and that prison staff knew he was regularly
missing meals due to his pain and difficulty in moving up and
down stairs. McDaniel was entitled to have the court assume
those facts in his favor in deciding the defendants’ motions
for summary judgment.
    In the following portions of this opinion, we first summa-
rize the material facts, filtering the evidence through the lens
of summary judgment procedure. Next, we turn to McDan-
iel’s ADA and Rehabilitation Act claims. We explain why dis-
putes of material fact remain related to the failure of the De-
partment of Corrections to accommodate McDaniel by refus-
ing him a no-stairs unit and why Eleventh Amendment sov-
ereign immunity does not bar his request for money damages
for this claim. We then explain why summary judgment for
defendants was proper on McDaniel’s two other failure-to-ac-
commodate claims. Finally, we explain why we affirm sum-
mary judgment for Dr. Syed on McDaniel’s separate Eighth
Amendment claim for deliberate indifference.
12                                                   No. 20-2946

II. Factual and Procedural History
    We set forth the facts in the light most favorable to McDan-
iel and give him the benefit of all reasonable inferences in his
favor, as required on summary judgment. E.g., Navratil v. City
of Racine, 

 (7th Cir. 2024). For more than four-
teen years, Carl McDaniel was a prisoner in the custody of the
Wisconsin Department of Corrections. When he filed this ap-
peal, McDaniel was in his early sixties and had extensive med-
ical problems, including hypertension, hyperthyroidism,
chronic obstructive pulmonary disease, stage 3 chronic kid-
ney disease, bladder tumors, type 2 diabetes complicated by
neuropathy, gout, fibromyalgia, anxiety, post-traumatic
stress disorder, bipolar disorder, chronic pain, peptic ulcer
disease, asthma, and degenerative joint disease in his spine
with spinal stenosis. McDaniel had developed some of these
ailments before his incarceration and others during.
     While incarcerated, McDaniel received medical treatment
for those ailments, including spinal surgery in the summer of
2017. Before that surgery, McDaniel used a wheelchair. After-
ward, he could move using a four-wheel walker. But McDan-
iel continued to experience other medical problems, including
degenerative joint disease of the spine and incontinence is-
sues, resulting in significant back pain and difficulty control-
ling urination and defecation. Following his spinal surgery,
the treating physician gave McDaniel several post-operative
instructions: he was to avoid “strenuous exercising,” “lift[ing]
more than 5–10 pounds,” and “bending, lifting, carrying,
twisting,” but the physician said he could “climb stairs.”
No. 20-2946                                                          13

    A. Problems at the Columbia Correctional Institution
    A few months after the spinal surgery, the Department of
Corrections transferred McDaniel to the Columbia Correc-
tional Institution. Before the transfer, McDaniel had re-
strictions in his file for a low-tier floor, no-stairs unit, low
bunk, and walker. At the new facility, however, a physical
therapist evaluated McDaniel and recommended changing
those restrictions. As part of the evaluation, McDaniel had
successfully walked up and down just six stairs. The therapist
concluded the no-stairs and low-tier restrictions were no
longer necessary. McDaniel’s eventual cell assignment, he
said, required him to walk up and down the stairs at least six-
teen times each day to access prison programs and activities,
including meals and the infirmary. Defendant Dr. Syed, one
of the facility’s treating physicians, approved discontinuing
those restrictions. McDaniel then received a walker, a cane,
and a double-occupancy cell with a low bunk, but in a unit
that was accessible only by stairs. 4
    The cell assignment created problems for McDaniel almost
immediately. For one, the stairs impeded his access to meals
and medications since the cafeteria and infirmary were on an-
other floor. McDaniel complained from the start that he was
not able to get out of his cell to eat or to retrieve his pain med-
ication. He eventually stopped attending most meals and tak-
ing his medications because of the pain from going up and
down the stairs to access those services. In the end, McDaniel


    4 At some point during McDaniel’s time at Columbia, he was moved

to a different double-occupancy cell. There were no relevant differences
between these two cells. Both required using stairs to attend meals and
retrieve medications.
14                                                             No. 20-2946

testified, he missed some 600 meals during his year at Colum-
bia.
    When McDaniel was able to navigate the stairs, he did so
with help. For instance, McDaniel would often purchase food
from the prison commissary. To pick up his orders, McDaniel
would use the goods he brought from the commissary to
“pay” other prisoners to help him up and down the stairs.
Other prisoners carried McDaniel’s walker for him while he
used the railing to move or sat and scooted down the stairs.
Sometimes other prisoners would even put their arms around
him and walk McDaniel up the stairs. But prison staff eventu-
ally forbade McDaniel from asking prisoners, guards, or any-
one else for help. Staff also told McDaniel he had to stop scoot-
ing down the stairs on his buttocks or he would get a “conduct
report.” 5
    McDaniel also had difficulty navigating his cell. In double-
occupancy cells that contain a toilet, people sometimes use so-
called “courtesy screens” to create some privacy. Most of the
time, McDaniel could use his walker to access the toilet. When
a courtesy screen was up, however, there was simply not
enough room to hold onto the walker when using the toilet.


     5 In McDaniel’s version of events, the walker did little to solve the

stairs problem: “It’s made out of steel and it’s got a chair on it…. I couldn’t
hold it with one hand.… But I couldn’t hold that and hold the rail and get
up and down the stairs….” McDaniel asserted under penalty of perjury
that his walker weighed about twenty-five pounds, well over the five-to-
ten-pound lifting restriction he was prescribed after his surgery. McDaniel
likewise contends that the cane did not help. To use the cane, McDaniel
also had to carry his walker since the walker was necessary to move once
he made his way up or down the stairs. Carrying both a walker and a cane,
he said, was too much for him to handle.
No. 20-2946                                                 15

As a result, McDaniel emphasizes, he had multiple falls mov-
ing around his cell and when using the toilet, which lacked
railings and support to hold.
    Toilet access was especially important for McDaniel. Since
he had difficulty controlling his bladder and bowels, at least
one doctor told McDaniel to practice timed voiding (going to
the bathroom in fixed time intervals, rather than by demand).
Without his own toilet and the ability to practice timed void-
ing, he would often soil himself. His cellmates, McDaniel
says, had difficulty with his timed voiding and accidents. He
contends that animosity contributed to a difficult living envi-
ronment that caused him significant stress and led to an alter-
cation with one cellmate.
    In addition, McDaniel’s bed also had a top bunk where a
cellmate slept. Due to what McDaniel described as a “lack of
flexibility in my entire spine,” he often hit his head and neck
on that bunk, contributing further to his pain. His cellmate
would also often hit McDaniel when climbing into the top
bunk.
   B. Requests for Accommodations
    McDaniel submitted several requests for accommodations
of his disabilities at Columbia. All were denied. A few days
after receiving his cell assignment, McDaniel asked for a “feed
in cell” restriction. His request was denied after a staff mem-
ber saw McDaniel walking around the unit. McDaniel later
sent two accommodation requests to the facility’s ADA coor-
dinator because of his “Fibromyalgia, Diabetes, (painful)
Neuropathy, [arthritis] of my Spinal Cord/Knees, need for
Mobility Impairment Device (walker).” The requests docu-
mented his falls trying to “access[] [the] unsafe toilet;”
16                                                No. 20-2946

instances where he struck his “Head/Neck on bunk;” and a
general “inability to access meds, food, services, programs,
and benefits from exacerbated pain [from] transitioning [the]
stairwell.” McDaniel also submitted a “Health Service Re-
quest” for a “handicap accessible cell.” The ADA Coordinator
responded to these submissions by explaining that McDan-
iel’s low-tier and no-stairs restrictions had been removed, so
he did not qualify for a “handicap cell.” No other actions were
taken.
    At an appointment with the facility’s Health Services
Unit—where Dr. Syed worked—McDaniel again asked for a
single-occupancy, wheelchair-accessible cell. He explained
that he “has pains and has no medication,” and “cannot go up
or down stairs.” Health Services staff told him that he did not
meet the criteria for a single-occupancy or wheelchair-acces-
sible cell and that “many/most ppl live w/ pain and he will
endure if he wants to do the activity.”
    McDaniel had more appointments with the Health Ser-
vices Unit. His complaints continued. McDaniel told the staff
about his chronic pain, lack of access to meals, and inconti-
nence issues. Despite these consistent complaints, Dr. Syed
and others did not modify McDaniel’s restrictions and contin-
ued to refuse him a cell on a floor where he would not need
to use stairs to access services, including meals. When
McDaniel again told Health Services staff that he was not tak-
ing his medications because it was too painful to go up and
down the stairs to retrieve them, staff members instructed
him to “take your medication as prescribed.” Others told him
to try physical therapy. Staff members told McDaniel that
movement would help him to avoid developing muscle atro-
phy. In the end, Health Services staff evaluated McDaniel at
No. 20-2946                                                   17

least forty-nine times during his year in the Columbia Correc-
tional Institution.
   While prison staff members, including Dr. Syed, contin-
ued to deny McDaniel any new accommodations or signifi-
cant changes in medical treatment, various doctors outside of
the facility assessed McDaniel. Those doctors came to differ-
ent conclusions about McDaniel’s care.
    To start, a nephrologist who treated McDaniel’s kidney
conditions visited him in his cell to conduct an exam. At that
time, McDaniel did not have a cellmate. The nephrologist
wrote that the “current singled cell is providing him this op-
tion [to do timed voiding] and I would recommend this to
continue as to avoid further complications and stress associ-
ated with” incontinence. Shortly after the nephrologist’s visit,
however, the facility gave McDaniel a cellmate and continued
to offer him diapers to help with his accidents. When the
nephrologist followed up with McDaniel a few months later,
she noted a significant decline in his condition. She wrote in
his chart that the “single cell status was previously signifi-
cantly helpful in minimizing issues and stress surrounding
bowel and bladder concerns,” and that timed voiding was
critical for treating his chronic kidney disease. McDaniel con-
tinued to live in a double-occupancy cell with a cellmate.
   Other doctors expressed similar opinions that contra-
dicted Health Services staff. A pain specialist, for instance, as-
sessed McDaniel and recommended that he be “put in [a] cell
with no top bunk,” which would help mitigate instances
18                                                            No. 20-2946

where he would hit his head and neck. McDaniel’s sleeping
arrangements did not change. 6
     C. Procedural History
    McDaniel filed this lawsuit against the Wisconsin Depart-
ment of Corrections, Dr. Syed, and others seeking both injunc-
tive and monetary relief. He alleged that the Department vio-
lated his rights under the ADA and the Rehabilitation Act by
refusing to accommodate his disabilities. McDaniel also al-
leged that Dr. Syed and others violated the Eighth Amend-
ment in various ways. 7


     6 After McDaniel had been at Columbia for just over a year, the De-

partment transferred him to the New Lisbon Correctional Institution.
Here, the facility shuffled McDaniel between no-stairs cells, normal dou-
ble-occupancy cells, and even a so-called “dry cell” (lacking a toilet). After
McDaniel filed this lawsuit, the facility changed course. It gave him a sin-
gle-occupancy cell with a toilet and a medical mattress. The staff lowered
the bottom bunk and raised the top bunk so McDaniel would not hit his
head getting in and out of bed. The facility also instituted a wheelchair
restriction for long distances, a shower chair restriction, and gave McDan-
iel diapers to help with his incontinence issues. While the vast majority of
McDaniel’s arguments concern the accommodations he was denied at Co-
lumbia, he also contends that New Lisbon’s accommodations were not
reasonable. The evidence underlying those claims is lacking by compari-
son and underdeveloped. We agree with the district court that no reason-
able jury could find for McDaniel on those claims, and we focus our dis-
cussion on Columbia.
     7 McDaniel initially brought claims against other prison officials at

Columbia and New Lisbon but did not pursue those claims on appeal. He
had also sought a preliminary injunction demanding accommodations of
his disabilities. The district court denied the injunction after the Depart-
ment assured the court it would keep McDaniel in a single-occupancy wet
cell for the length of the case. After the district court granted summary
judgment, the Department moved McDaniel to yet another facility where
No. 20-2946                                                               19

   McDaniel litigated in the district court pro se, with one ex-
ception. The district court appointed counsel for the limited
purpose of helping McDaniel file an amended complaint. The
appointed counsel then withdrew with court approval. Upon
the close of discovery, the defendants moved for summary
judgment. As discussed above, the district court granted the
defendants’ motion after largely discounting McDaniel’s fac-
tual statements.
    After we heard oral argument in this appeal, McDaniel
was released from prison, which rendered moot his requests
for injunctive relief. In February 2024, McDaniel died. We
granted his son’s motion to be substituted as the plaintiff in
this case, acting as executor of McDaniel’s estate. See Fed. R.
App. P. 43(a)(1); Smith v. First Hospital Laboratories, Inc., 

, 607 (7th Cir. 2023) (proceeding with appeal after
substituting executor of plaintiff’s estate as plaintiff). 8
III. Eleventh Amendment Sovereign Immunity
   Sovereign immunity bears on whether a federal court may
hear a case, so we address it before reaching the merits. See
Seminole Tribe of Florida v. Florida, 

, 64–65 (1996).
The district court quite reasonably chose to avoid “thorny
questions of sovereign immunity” under the ADA by

he claimed he faced challenges similar to those complained of here. See
McDaniel v. Wisconsin Dep’t of Corrections, No. 21-3048, 

(7th Cir. June 6, 2022) (vacating denial of preliminary injunction).
    8 Wisconsin law provides for survival of a plaintiff’s claims for per-

sonal injuries like McDaniel’s. 

(1)(am)(7) (causes of ac-
tion for “other damage to the person” survive death of plaintiff); see, e.g.,
Sawyer v. Midelfort, 

, 151–54, 

, 436–38 (1999)
(claim for psychological damage caused by medical malpractice survived
death of plaintiff).
20                                                    No. 20-2946

analyzing McDaniel’s reasonable accommodation claims un-
der the Rehabilitation Act. See McDaniel v. Syed, No. 17-cv-
01493, 

, at *7 (E.D. Wis. Sept. 17, 2020), citing
Jaros v. Illinois Dep’t of Corrections, 

, 671–72 (7th
Cir. 2012). Because of McDaniel’s release from prison and
later death, however, the only remedy available if McDaniel
succeeds on his reasonable accommodation claim is money
damages. This makes the issue of Eleventh Amendment state
sovereign immunity more critical. Relief available under Title
II of the ADA and the Rehabilitation Act is “coextensive,” Ja-
ros, 

, and Wisconsin has waived its immunity
from suits for damages under the Rehabilitation Act as a con-
dition of its receipt of federal funds. See Stanley v. Litscher, 

 (7th Cir. 2000). We do not think this ends our
inquiry, though. We think it prudent to address whether sov-
ereign immunity would bar McDaniel from seeking money
damages under Title II of the ADA.
    Congress may abrogate state sovereign immunity when
exercising its enforcement power conferred by section 5 of the
Fourteenth Amendment. College Savings Bank v. Florida Prepaid
Postsecondary Education Expense Bd., 

 (1999).
The ADA provides: “A State shall not be immune under the
eleventh amendment to the Constitution of the United States
from an action in Federal or State court of competent jurisdic-
tion for a violation of this chapter.” 

. The Su-
preme Court has recognized this statement as an unequivocal
expression of Congress’s intent to abrogate state sovereign
immunity. See United States v. Georgia, 

 (2006);
Board of Trustees of Univ. of Alabama v. Garrett, 

,
363–64 (2001); see also Seminole Tribe, 

 (“In order
to determine whether Congress has abrogated the States’ sov-
ereign immunity, we ask two questions: first, whether
No. 20-2946                                                      21

Congress has ‘unequivocally expresse[d] its intent to abrogate
the immunity,’ and second, whether Congress has acted ‘pur-
suant to a valid exercise of power.’” (alteration in original)
(quoting Green v. Mansour, 

 (1985))).
   Whether Congress validly exercised its section 5 enforce-
ment power in the ADA is a separate question. The Supreme
Court explored this question in United States v. Georgia, 

 (2006), and explained that there are two paths by
which Congress could have validly abrogated state sovereign
immunity under Title II of the ADA.
    First, a plaintiff can show that his claim falls into the cate-
gory of valid prophylactic legislation Congress enacted under
section 5 following the three-step inquiry articulated in Ten-
nessee v. Lane: (1) identify the rights at issue, (2) identify the
pattern of violations the legislation is designed to remedy and
prevent, and (3) determine whether the legislation is congru-
ent with and proportional to the pattern of violations. 

, 522–34 (2004); see also City of Boerne v. Flores, 

 (1997) (holding that Congress may enact prophylactic leg-
islation to remedy or prevent unconstitutional discrimination
under section 5 of the Fourteenth Amendment if the legisla-
tion exhibits “a congruence and proportionality between the
injury to be prevented or remedied and the means adopted to
that end”).
    Alternatively, as in Georgia, Title II of the ADA validly ab-
rogates state sovereign immunity for conduct that also repre-
sents a violation of the Fourteenth Amendment. A plaintiff
taking this route need not satisfy the congruence and propor-
tionality inquiry under Lane and Boerne because the plaintiff
does not seek to hold a state liable for damages for conduct
that is constitutional. In these cases, ADA Title II liability acts
22                                                             No. 20-2946

not as “prophylactic” legislation but as a remedy for an actual
constitutional violation.
    We explain below that the deprivation of food that
McDaniel argues violates Title II of the ADA would also vio-
late the Eighth Amendment’s prohibition on cruel and unu-
sual punishment, as incorporated against the states through
the Fourteenth Amendment (or at least a reasonable jury
could find as much). Therefore, regardless of whether relief is
granted under the Rehabilitation Act or Title II of the ADA,
the Wisconsin Department of Corrections is not immune from
liability for money damages under the Eleventh Amend-
ment. 9 We return to this issue in more detail below, after ad-
dressing the merits of McDaniel’s ADA and Rehabilitation
Act claims, including the availability of money damages.
IV. ADA and Rehabilitation Act Claims
   We review de novo the district court’s grant of summary
judgment, giving the non-moving party the benefit of

     9 McDaniel could recover damages under either the ADA or the Re-

habilitation Act but not both. He could have only one recovery for the
same injury. See Duran v. Town of Cicero, 

 (7th Cir. 2011)
(a plaintiff may have but one recovery); Calero–Cerezo v. United States Dep't
of Justice, 

, 11 n. 1 (1st Cir. 2004) (dismissal of ADA claim had no
effect on scope of remedy because Rehabilitation Act claim remained). De-
spite this, some recent court decisions have still considered the issue of
sovereign immunity under both statutes before resolving plaintiffs’ claims
on the merits, as we have done here. See, e.g., Durham v. Kelley, 

, 227–29 (3d Cir. 2023); but see Bennett-Nelson v. Louisiana Bd. of Regents,

 (5th Cir. 2005) (explaining that “having already held that
sovereign immunity does not bar the appellants’ claim under [the Reha-
bilitation Act], we need not address at this juncture the issue of abrogation
under Title II of the ADA, because the rights and remedies under either
are the same for purposes of this case”).
No. 20-2946                                                   23

conflicts in the evidence and all reasonable inferences in his
favor. Navratil, 

. Summary judgment is appro-
priate when the moving party shows there is no genuine dis-
pute as to any material fact and it is entitled to judgment as a
matter of law. Fed. R. Civ. P. 56(a). “A dispute of material fact
is genuine ‘if the evidence is such that a reasonable jury could
return a verdict for the nonmoving party.’” Johnson v.
Dominguez, 

 (7th Cir. 2021), quoting Zaya v.
Sood, 

 (7th Cir. 2016).
   A. Legal Standard
     McDaniel contends that the Wisconsin Department of
Corrections violated the ADA and the Rehabilitation Act by
refusing to accommodate his physical impairments, resulting
in the denial of access to programs and services. Title II of the
ADA provides that “no qualified individual with a disability
shall, by reason of such disability, be excluded from partici-
pation in or be denied the benefits of the services, programs,
or activities of a public entity, or be subjected to discrimina-
tion by any such entity.” 

. Section 504 of the
Rehabilitation Act provides: “No otherwise qualified individ-
ual with a disability … shall, solely by reason of her or his
disability, be excluded from the participation in, be denied the
benefits of, or be subjected to discrimination under any pro-
gram or activity receiving Federal financial assistance.” 

(a). The relief available under the ADA and the
Rehabilitation Act is “coextensive.” Jaros, 

.
“‘[C]ourts construe and apply [the statutes] in a consistent
manner,’ and our evaluation of [a plaintiff’s] claims under
both [requires] the same analysis.” A.H. ex rel. Holzmueller v.
Illinois High School Ass’n, 

 (7th Cir. 2018),
24                                                            No. 20-2946

quoting Radaszewski ex rel. Radaszewski v. Maram, 

 (7th Cir. 2004). 10
    To avoid summary judgment under the ADA and the Re-
habilitation Act, McDaniel must offer evidence that “(1) he is
a qualified person (2) with a disability and (3) the Department
of Corrections denied him access to a program or activity be-
cause of his disability.” Jaros, 

. The Department
disputes only the third element. If McDaniel offers evidence
that could support a jury finding in his favor on that element,
“the burden shifts to the [Department] to prove that the re-
quested accommodation would impose an undue hardship.”
Conners v. Wilkie, 

 (7th Cir. 2021); see also
Oconomowoc Residential Programs, Inc. v. City of Milwaukee, 

 (7th Cir. 2002) (“An accommodation is unreason-
able if it imposes undue financial or administrative burdens
or requires a fundamental alteration in the nature of the pro-
gram.”). 11


     10 There are a few differences between the ADA and the Rehabilitation

Act, but they do not affect the merits of McDaniel’s claims at summary
judgment. See Jaros, 

 (Rehabilitation Act claim requires as
additional element the receipt of federal funds, which all states accept for
their prisons); see also, e.g., Reed v. Columbia St. Mary’s Hospital, 

 (7th Cir. 2019) (noting key difference between ADA and Rehabil-
itation Act regarding defendant’s intent).
     11 Reasonable accommodation claims under Title II of the ADA and

Section 504 of the Rehabilitation Act are firmly part of both statutes, even
though they do not contain specific language on point. See A.H., 

 (“While Title II and Section 504 of the Rehabilitation Act lack such
specific reasonable accommodation language, their corresponding regula-
tions employ language indicating that entities must provide reasonable
accommodations to the disabled.”); see also Reed, 

 (“The
Rehabilitation Act does not contain an explicit accommodation
No. 20-2946                                                      25

    It is well established that “[r]efusing to make reasonable
accommodations is tantamount to denying access.” Jaros, 

. Just as an employer is not obliged to provide an
employee with a disability the particular accommodation he
requests or prefers, Mobley v. Allstate Insurance Co., 

 (7th Cir. 2008), prison officials are not required to pro-
vide a prisoner with disabilities the particular accommoda-
tions he requests or prefers. Rather, “the [defendant] need
only provide some reasonable accommodation,” 

 (internal
quotation omitted), that ensures that the person with disabil-
ities has “equal access to the benefits of” programs or activi-
ties. See Wisconsin Community Services, Inc. v. City of Milwau-
kee, 

 (7th Cir. 2006) (en banc) (zoning re-
strictions affecting health care for persons with disabilities,
addressed under Rehabilitation Act and Title II of ADA).
    In a prison, qualifying programs and activities include
meals, medical care, showers, toilets, and the like. See Georgia,

; Jaros, 

. Whether an accommo-
dation satisfies these requirements is a “highly fact-specific
inquiry,” whether in employment or in prison. See McAllister
v. Innovation Ventures, LLC, 

 (7th Cir. 2020)
(internal quotation omitted).
   To win compensatory damages under the statutes,
McDaniel must also offer evidence that the Department of
Corrections was intentionally discriminatory or at least delib-
erately indifferent to its violation. Lacy v. Cook County, 

, 862–63 (7th Cir. 2018) (agreeing with most circuits
that deliberate indifference is sufficient to prove intentional


requirement, but the Supreme Court has located a duty to accommodate
in the statute generally.”).
26                                                         No. 20-2946

discrimination under failure-to-accommodate claims). That
requires “both (1) knowledge that a harm to a federally pro-
tected right is substantially likely, and (2) a failure to act upon
that likelihood.” 

, quoting S.H. ex rel. Durrell v. Lower
Merion School District, 

 (3d Cir. 2013) (internal
quotation omitted). 12
     B. Reasonable Accommodations
    McDaniel asserts that the Department of Corrections
failed to provide reasonable accommodations by denying him
(1) a no-stairs unit, (2) a single-occupancy wet cell, and (3) a
cell without a top bunk. We take these issues in turn.
        1. No-Stairs Unit
    After McDaniel was transferred to Columbia, Dr. Syed re-
moved his low-tier, no-stairs restriction upon a recommenda-
tion by the physical therapist who evaluated McDaniel. He
was then placed in a cell in a unit that would require him to
go up and down stairs in his daily activities. We assume that
the initial cell assignment was reasonable at first. The health-
care professionals at the facility believed McDaniel needed to
use stairs to improve mobility and to avoid atrophy after his
recent spinal surgery. That accommodation was also in line
with the spinal surgeon’s post-operative instructions. The
question for us, however, is whether the denial of a no-stairs
unit became unreasonable after McDaniel’s problems access-
ing services became evident and the Department still refused
his repeated requests for a no-stairs unit.


     12 A plaintiff can win compensatory damages under the Rehabilitation

Act but not damages for emotional distress. Cummings v. Premier Rehab
Keller, P.L.L.C., 

 (2022).
No. 20-2946                                                 27

    On this record, the evidence on denial of access is suffi-
cient to defeat summary judgment for the Department.
McDaniel needed to make his way up and down stairs to par-
ticipate in various prison programs and activities, including
ones as basic as meals and medical care. McDaniel offered ev-
idence that, during his year at Columbia, he missed some 600
meals and many doses of his medications because the stairs—
which he often could not climb or descend due to the pain of
doing so—impeded his access. Accommodations must give
“meaningful access to the benefit that the grantee offers.” Al-
exander v. Choate, 

 (1985). A reasonable jury
could find that missing nearly two meals a day on average
meant McDaniel did not have “meaningful access” to meals.
The same is true of his access to medications. On this record,
a reasonable jury could find that requiring McDaniel to walk
up and down stairs for meals and medications was not rea-
sonable.
    The district court, however, found that McDaniel’s cell as-
signment was reasonable because he was physically able to
walk up and down stairs to access prison programs, even if it
was more painful to do so. The court pointed to the fact that
some prison officials had observed McDaniel managing to go
up or down stairs a few times. That reasoning may or may not
be persuasive at trial, but it is not consistent with the sum-
mary judgment standard. McDaniel presented evidence that
he could not navigate the stairs often enough to meet his basic
needs on a daily basis. He also explained that the occasions
when prison officials had observed him navigate the stairs
were the rare times that he tried the stairs to request accom-
modations or to avoid starvation.
28                                                          No. 20-2946

    Giving McDaniel the benefit of conflicting evidence, we
cannot say beyond reasonable dispute that the Department
was reasonable in choosing to keep housing him in a unit re-
quiring him to go up and down stairs many times each day to
gain access to prison programs, benefits, and services, includ-
ing meals and medications. Ample evidence could support a
jury finding of the exact opposite—that it was unreasonable
to refuse McDaniel’s requests to be placed in a no-stairs unit.
That holds true even if McDaniel could and did manage to go
up and down stairs occasionally, and often with help. 13
    The district court also suggested that McDaniel’s walker
was an adequate accommodation for the stair problem, so that
McDaniel was not denied access to programs or services by
living in a unit with stairs. Applying the summary judgment
standard, we again must disagree. McDaniel offered evidence
that his walker weighed about twenty-five pounds, and he
was directed not to lift more than ten pounds. He also pro-
vided evidence that he could not use the walker to move up
and down stairs and often relied on other prisoners to carry
his walker for him so he could hold onto the railing. If a pris-
oner needs help from other prisoners to access programs,
however, the general rule is that the accommodation is inef-
fective and inadequate. Wright v. New York State Dep’t of Cor-
rections, 

 (2d Cir. 2016) (reversing summary
judgment for defense); see also American Council of the Blind v.


     13 The evidence McDaniel offered that he had access on average to

only one meal per day is consistent with prison officials noting they some-
times saw McDaniel using the stairs successfully. The issue is whether a
reasonable jury would be required to find that McDaniel’s access to only
one meal per day constituted “meaningful access” to the relevant prison
program, meals. See Alexander, 

.
No. 20-2946                                                           29

Paulson, 

 (D.C. Cir. 2008) (affirming
summary judgment for plaintiff; Rehabilitation Act’s empha-
sis on self-sufficiency should ensure that “enjoyment of a pub-
lic benefit is not contingent upon the cooperation of third per-
sons”). The walker aided McDaniel in attending meals only if
a friend carried the walker up the stairs, which then allowed
him to use the walker to move freely around the cafeteria. A
reasonable accommodation cannot be one that requires the
aid of other prisoners. 14
           a. Medical Judgment?
    The Department contends that the decision to house
McDaniel in a unit with stairs was a form of medical treat-
ment, which it says dooms his claim. As a general matter, the
ADA and the Rehabilitation Act do not apply to issues of al-
legedly inadequate medical treatment. See Reed, 

 n.6 (“The Rehabilitation Act and the Americans with Dis-
abilities Act do not create a remedy for medical malprac-
tice.”); Bryant v. Madigan, 

 (7th Cir. 1996) (ex-
plaining that ADA is not violated by “a prison’s simply failing
to attend to the medical needs of its disabled prisoners”).
     As the Department sees the issue, McDaniel must prove
that medical decisions had no bearing on the denials of his
accommodation requests for a no-stairs unit because other-
wise he cannot show that he was denied access to programs
or services because of his disability. A contrary rule, the De-
partment says, “would lead to the absurd result of creating
litigation risk whenever medical staff deny [a prisoner’s]

   14 The cane likewise failed to solve the problem. It required McDaniel

to walk with a cane while also carrying his walker. McDaniel contends
that he could not use or carry both simultaneously.
30                                                   No. 20-2946

requested treatment based on their medical judgments and
observations.” In this case, the Department contends, it de-
nied McDaniel a no-stairs unit because it was deferring to the
reasoned medical judgment of the facility’s staff that he did
not need such a restriction.
    The Department’s general point is correct. When prisoners
are unhappy with the medical care they have received, legal
redress may be available through medical malpractice suits or
Eighth Amendment suits, not under the ADA or the Rehabil-
itation Act. But when it comes to issues of mobility affecting
access to programs (here, principally meals and medical care),
that argument runs against the weight of recent authority, at
least as applied to McDaniel’s evidence.
    Starting with the Supreme Court, in Georgia, the Court ad-
dressed whether a prisoner with a disability in state prison
could sue the state for damages under Title II of the ADA. 

. When discussing whether the conduct at issue vi-
olated the Act in the first place, the Court explained that an
“alleged deliberate refusal of prison officials to accommodate
[a plaintiff’s] disability-related needs in such fundamentals as
mobility” could constitute an ADA violation because those de-
cisions could lead to the “‘exclu[sion] from participation in or
… deni[al of] the benefits of’ the prison’s ‘services, programs,
or activities.’” 

 (alterations and omission in original;
emphasis added), quoting 

. That statement
clearly assumes that the ADA and the Rehabilitation Act ad-
dress mobility issues that affect a prisoner’s ability to partici-
pate equally in programs and services, even if they might also
relate to medical decisions. At the very least, those decisions
are not entirely off-limits from scrutiny under the ADA and
Rehabilitation Act.
No. 20-2946                                                            31

    Since Georgia, other circuits have treated decisions related
to a prisoner’s mobility as disability accommodation issues,
not just as issues of allegedly inadequate medical treatment,
even when medical staff were directly involved in denying a
prisoner a claimed reasonable accommodation.
    For example, in Wright, the Second Circuit treated the de-
cision to deny a prisoner a motorized wheelchair as an accom-
modation issue. 

. Wright had received a
“quad cane, a manual wheelchair, use of his customized cush-
ion, knee pads, wheelchair accessible living space, and access
to mobility aides from the mobility assistance program.” 

. But he testified that even with those accommodations, he
was “unable to visit the law library,” “missed multiple morn-
ing sick calls, doctor appointments, and meals,” and “defe-
cated or urinated on himself on more than one occasion” be-
cause he could not reach the bathroom quickly enough. 

    The court found it obvious that these shortcomings were
“examples of Wright being denied meaningful access to
prison services, programs, and activities.” 

 The court also
took particular issue with Wright’s forced reliance on other
prisoners to navigate prison programs, which was “funda-
mentally in tension with the ADA and [the Rehabilitation
Act’s] emphasis on independent living and self-sufficiency.”

 at 74–75 (internal quotation omitted). The Second Circuit
reversed summary judgment for the defendants, concluding
that a reasonable jury could find that a motorized wheelchair
was a reasonable accommodation. 15


    15 The Department of Corrections tries to distinguish Wright because

the prison there failed to engage in an individual assessment of the pris-
oner’s needs when it denied him a wheelchair. In Wright the prison had
32                                                          No. 20-2946

    In another similar case, the Fifth Circuit recognized the
ADA could offer relief for a denial of accommodations the
plaintiff needed to move within a jail. In Cadena v. El Paso
County, 

 (5th Cir. 2020), Cadena was incarcerated
for failing to appear in court. Three days before her arrest, she
had undergone surgery on her right leg. She used a wheel-
chair as she recovered. Upon arrival at the jail, a nurse con-
ducted an intake evaluation. The nurse determined that Ca-
dena could stand “independently” because she had “stood
during the intake when asked to do so.” 

. Cadena,
however, told the nurse that she could not walk, given her re-
cent surgery. The facility physician decided that Cadena
needed crutches but not a wheelchair. The facility also denied
her requests for “a modified food delivery procedure, and
various forms of medical care.” 

. At least one person,
but not the treating physician, told Cadena that the facility
could not accommodate a wheelchair.
   The crutches, like the stairs for McDaniel, created prob-
lems for Cadena from the start. She could not safely navigate
the facility on crutches and told staff members at least three
times that she needed a wheelchair. One officer testified that
she saw Cadena fall as she tried to use the crutches. The
crutches also impeded her ability to access meals. She could

maintained a blanket policy banning motorized wheelchairs. Here, by
contrast, McDaniel was evaluated many times by prison staff, and they
determined his requested accommodations were not medically necessary.
Whether individualized assessments occurred, however, does not resolve
the issue of whether the accommodations resulting from such assessments
were reasonable. Defendants cannot avoid liability under the statutes by
conducting individualized assessments if the result is a failure to provide
reasonable accommodations ensuring meaningful access to programs or
activities. This is an issue for trial.
No. 20-2946                                                    33

not carry her food tray and use the crutches at the same time.
But jail officials “continued to refuse the requested accommo-
dation despite indications that further accommodation was
necessary.” 

.
    In reversing summary judgment for the defense on the
reasonable accommodation issue, the Fifth Circuit rejected
the defendant’s argument that it properly deferred to the phy-
sician’s “medical judgment that Cadena did not need a wheel-
chair.” 

 The court first explained that the Supreme Court
and the Second Circuit had treated “mobility aids” as “disa-
bility accommodations.” 

 citing Georgia, 

,
and Wright, 

. In addition, there were reasons to
doubt whether the physician actually intended for Cadena
not to have access to a wheelchair, and other staff had explic-
itly recommended that she receive one. Thus, “the [defend-
ant’s] characterization that it was merely deferring to a rea-
soned medical judgment [was] inaccurate.” Id. at 727.
    These cases indicate a general principle that decisions im-
peding a prisoner’s ability to move freely throughout a facility
and discouraging his participation in prison activities can be
addressed under the ADA and the Rehabilitation Act. See also
Koon v. North Carolina, 

, 401–02, 405–06 (4th Cir.
2022) (treating medical professionals denying prisoner a
handicap pass to use library without climbing stairs as an ac-
commodation issue under the ADA); Brooks v. Colorado Dep’t
of Corrections, 

, 1164–65, 1172 (10th Cir. 2021) (re-
versing summary judgment for defendants under ADA; trial
required to decide whether provision of adult diapers was a
reasonable accommodation for prisoner with ulcerative colitis
that caused him to miss hundreds of meals per year after
prison’s clinical services denied prisoner a movement pass
34                                                 No. 20-2946

that would have allowed him to access meals more flexibly);
see also Furgess v. Pennsylvania Dep't of Corrections, 

 (3d Cir. 2019) (explaining “complaints about not be-
ing provided an accessible shower are not allegations of med-
ical malpractice or disagreements about medical treatment.
They are requests for reasonable accommodations so that in-
mates with disabilities can take a shower—just like able-bod-
ied inmates”). Such claims are not barred as a matter of law
even if the denial of an accommodation can be described in
some respects as a “medical decision.”
    Our decision in Bryant, 

, does not conflict
with this view; the case is readily distinguishable from this
situation. Bryant was a prisoner with paraplegia. He sued a
prison after it had refused his request for guardrails for his
bed and as a result, he fell out of his bed and broke his leg.
Bryant also complained that he was denied medication after
surgery to fix his broken leg. Bryant argued these actions vio-
lated, in part, the ADA. We rejected his claim.
     We emphasized two important points. First, Bryant had
not complained “of being excluded from some prison service,
program, or activity.” 

. Instead, he took issue with
“incompetent treatment of his paraplegia,” which the ADA
does not address. 

 Second, we emphasized that
“[s]tandards of medical care are not irrelevant to the [ADA].
Disabled people often cannot participate in programs and ac-
tivities unless special attention is given to their medical
needs.” 

 That was not Bryant’s case because he did not
claim he was denied access to a program or activity. McDan-
iel, by contrast, has offered evidence that he was in fact denied
No. 20-2946                                                                35

access to qualifying programs and services because the De-
partment refused to assign him to a no-stairs unit. 16
    We read these cases, taken together, as establishing a few
general principles. First, the ADA and the Rehabilitation Act
do not apply when a prisoner simply disagrees with his
course of medical treatment. Second, simple disagreement
with treatment is different from cases where, as here, a plain-
tiff offers evidence that the choice to reject his accommodation
requests directly affected his mobility, preventing him from
moving freely throughout the facility and impairing or pre-
venting his participation in prison activities. “Disabled people
often cannot participate in programs and activities unless spe-
cial attention is given to their medical needs.” Bryant, 

. Consistent with Georgia and the later circuit cases cited
above, the evidence here raises issues under the ADA and the




    16 The Department also relies on Fitzgerald v. Corrections Corp. of Amer-

ica, 

 (10th Cir. 2005), but the situation there is also readily
distinguishable from McDaniel’s mobility issues. Fitzgerald broke his hip
while incarcerated. The treating physician advised the prison that a surgi-
cal procedure was the best form of treatment, but that another acceptable
course of treatment was to do nothing. The facility chose to do nothing.
Fitzgerald sued, asserting that the physician’s recommendation that the
facility may “do nothing” violated his rights under the ADA and the Re-
habilitation Act. The Tenth Circuit rejected his claim, explaining that a sur-
gery is something that Fitzgerald “would not have been ‘otherwise quali-
fied’ for … in the absence of his alleged disability.” 

. Whether to
have surgery or not was “the sort of purely medical decision[] that we
have held [does] not ordinarily fall within the scope of the ADA or the
Rehabilitation Act.” 

 Fitzgerald did not argue that he was denied access
to a program or service because of his disability. The sole issue was his
disagreement with the treatment he received.
36                                                  No. 20-2946

Rehabilitation Act, not just medical malpractice or Eighth
Amendment health-care claims.
    Whether to house McDaniel in a unit with stairs presented
an accommodation issue since it directly related to his mobil-
ity. If McDaniel could not access the cafeteria if he lived in a
unit with stairs but could if he lived in a unit without them,
then a no-stairs restriction could qualify as a mobility aid. The
choice to assign him to a unit with stairs affected his ability to
move freely around the prison, and, according to McDaniel’s
evidence, resulted in his missing 600 meals in one year, as well
as many doses of medications.
    McDaniel has shown a material dispute as to whether
housing him in a unit with stairs was a reasonable accommo-
dation. McDaniel never claimed he was incapable of ever
making his way up and down stairs. His case has always been
that stairs were too difficult and painful for him to access
meals and medications on a regular basis. The Department’s
justification that the cell assignment was necessary because
movement, like walking up and down stairs, could help
McDaniel avoid developing muscle atrophy does not compel
summary judgment in its favor. Even if the decision was rea-
sonable when McDaniel was first transferred and was recov-
ering from his spinal surgery, McDaniel’s evidence shows
that as time went on, he struggled to the point that he was
missing medications and an average of two meals a day.
Faced with that evidence, a jury could find that it eventually
became unreasonable for the prison to deny a non-stairs as-
signment. We recognize, of course, that doctors often give
treatment instructions that patients do not agree with and
may even find painful, such as stressing movement after sur-
gery. But our task is assessing whether McDaniel received
No. 20-2946                                                   37

meaningful access to prison programs, and to make that as-
sessment by giving McDaniel the benefit of conflicts in the ev-
idence. As months went by and he was relegated to asking
other prisoners for assistance or even scooting up and down
stairs on his buttocks for meals, medications, and other ser-
vices, there is a genuine factual dispute over whether the cell
assignment continued to be reasonable.
    McDaniel has offered evidence to establish a prima facie
case that denying him a no-stairs unit amounted to a failure
to accommodate his disabilities. The Department has not ar-
gued that McDaniel’s requested accommodation—a no-stairs
unit—would have imposed an undue hardship on prison of-
ficials. McDaniel’s evidence thus supports a triable claim that
the Department violated his rights under the ADA and the
Rehabilitation Act during his time at Columbia.
          b. Compensatory Damages
    The next issue is whether a reasonable jury could award
McDaniel compensatory damages, which, under the ADA
and Rehabilitation Act, would require a finding that the De-
partment was at least deliberately indifferent to his lack of ac-
cess. Lacy, 

. Deliberate indifference, again, re-
quires that “the defendant knew that harm to a federally pro-
tected right was substantially likely and … failed to act on that
likelihood.” 

 (omission and emphases in original; in-
ternal quotation omitted).
   As explained, McDaniel offered evidence that the stairs
prevented his access to meals and medication. He and the de-
fendants also offered evidence that he conveyed that fact re-
peatedly to various facility staff members during his year at
Columbia. All his requests for a no-stairs unit were denied,
38                                                  No. 20-2946

and his cell assignment went unchanged. A reasonable jury
could find that the Department, by refusing to change
McDaniel’s disability-related restrictions and to place him in
a no-stairs unit, even after knowing he was missing meals and
medication dosages, was deliberately indifferent to violations
of McDaniel’s “federally protected right[s]” under the ADA
and the Rehabilitation Act. 

 (internal quotation omitted). At
bottom, McDaniel has offered enough evidence to defeat sum-
mary judgment on this failure-to-accommodate claim for
money damages. We reverse the district court’s decision to the
contrary.
          c. Eleventh Amendment Sovereign Immunity and the
             Eighth Amendment’s Prohibition on Cruel and Un-
             usual Punishment
    Having set out the merits of McDaniel’s reasonable-ac-
commodation claim regarding the denial of a no-stairs unit,
we return to the issue of sovereign immunity. If a reasonable
jury could conclude that one or more responsible prison offi-
cials were deliberately indifferent to McDaniel’s federally
protected rights under the ADA, then a reasonable jury could
also find that same conduct violated the Eighth Amendment.
This point is important, because it means that, for purposes of
McDaniel’s ADA Title II claim for money damages, Congress
could validly abrogate state sovereign immunity under the
Eleventh Amendment. See Georgia, 

 (“[I]nsofar
as Title II creates a private cause of action for damages against
the States for conduct that actually violates the Fourteenth
Amendment, Title II validly abrogates state sovereign im-
munity.” (emphasis original)).
   We discuss below McDaniel’s Eighth Amendment claim
against Dr. Syed for deliberate indifference to medical needs.
No. 20-2946                                                  39

McDaniel’s Title II ADA claim is comparable to a “conditions
of confinement” claim under the Eighth Amendment. See
Farmer v. Brennan, 

 (1994) (explaining that
Eighth Amendment imposes duties on prison officials to
“provide humane conditions of confinement”).
   “Adequate food and facilities to wash and use the toilet are
among the ‘minimal civilized measure of life’s necessities’
that must be afforded prisoners.” Jaros, 

, quot-
ing Rhodes v. Chapman, 

 (1981), and citing Wil-
son v. Seiter, 

 (1991). The Supreme Court has
recognized that the food prisoners are fed is a “condition” of
confinement. Wilson, 

. Prison officials are liable
under the Eighth Amendment for depriving an inmate of hu-
mane conditions of confinement if the official is deliberately
indifferent to a substantial risk of harm from that deprivation.
See Farmer, 

.
    We explained above why a reasonable jury could conclude
that prison officials were deliberately indifferent to McDan-
iel’s lack of access to prison programs, including meals. We
also think it obvious that depriving a prisoner of nearly two
meals a day for an entire year can amount to a substantial risk
of harm. See Reed v. McBride, 

, 853–54 (7th Cir.
1999) (reversing summary judgment; prisoner missing meals
three to five days at a time was a “sufficiently serious” depri-
vation to constitute an Eighth Amendment violation); accord,
Foster v. Runnels, 

, 812–13 (9th Cir. 2009) (revers-
ing summary judgment; depriving prisoner of sixteen meals
in twenty-three days was sufficiently serious deprivation of a
life necessity to establish Eighth Amendment violation); Sim-
mons v. Cook, 

, 807–09 (8th Cir. 1998) (upholding
damage award for Eighth Amendment violation where
40                                                No. 20-2946

paraplegic prisoners missed four consecutive meals because
their wheelchairs could not access food tray slots, depriving
them of “the minimal civilized measure of life’s necessities,”
quoting Farmer, 

); Cooper v. Sheriff, Lubbock
County, 

 (5th Cir. 1991) (deprivation of ad-
equate food for significant periods of time is a “form of cor-
poral punishment” forbidden by the Eighth Amendment). Be-
cause the conduct that supports McDaniel’s Title II ADA
claim would also amount to a violation of the Eighth Amend-
ment, the Eleventh Amendment does not bar him from seek-
ing money damages against the Wisconsin Department of
Corrections. He is seeking recompense for an actual constitu-
tional violation.
      2. Single-Occupancy Wet Cell
    We turn now to McDaniel’s assertion that placing him in a
double-occupancy cell failed to accommodate his disabilities.
Again, to survive summary judgment on this issue, McDaniel
needed to offer evidence that the Department of Corrections
denied him access to a program or activity because of his dis-
ability. Unlike his claim for a no-stairs unit, this claim pre-
sented a medical treatment dispute. Relief is not available un-
der the ADA and the Rehabilitation Act, and the district court
properly granted summary judgment on the claim.
    McDaniel contended that the double-occupancy wet cell
was not a reasonable accommodation for his incontinence and
therefore impeded his access to the toilet. Staff at Columbia
denied McDaniel’s request for a single-occupancy cell be-
cause they did not believe one was medically necessary. These
conflicting positions indicate the core dispute was and contin-
ues to be over the best treatment of incontinence, not McDan-
iel’s access to a toilet.
No. 20-2946                                                   41

    We draw our understanding from the nephrologist her-
self, whose recommendations McDaniel relies upon here. She
said that the “current single[] cell is providing him this option
[to do timed voiding] and I would recommend this to con-
tinue as to avoid further complications and stress associated
with” incontinence; and in a follow-up, “single cell status was
previously significantly helpful in minimizing issues and
stress surrounding bowel and bladder concerns.” Her recom-
mendations for a single-occupancy cell were based on what
she believed McDaniel needed to treat his incontinence issues
and to practice timed voiding. The Department denied
McDaniel a single-occupancy cell because it disagreed with
the nephrologist and McDaniel that one was medically neces-
sary. These disagreements are more akin to Bryant and that
plaintiff’s concerns with the prison’s alleged “incompetent
treatment of his paraplegia.” 

. In this case,
McDaniel took issue with what he saw as incompetent treat-
ment of his incontinence. This seems more like a treatment is-
sue, not an accommodation issue.
    McDaniel tried to present this issue as one regarding toilet
access, but we are not convinced. McDaniel testified that he
would often fall off the toilet because he could not access it
with his walker, which he needed for balance, when the cour-
tesy screen was up in his cell. If a prisoner could not access a
toilet because the bathroom could not accommodate a wheel-
chair, for instance, that could present potential issues under
the ADA and the Rehabilitation Act. See Georgia, 

 (ADA violation was “quite plausible” since bathroom
was not equipped for wheelchair access). If the concern were
simply the courtesy screen blocking his ability to access the
toilet, that would be one thing. But McDaniel went a step fur-
ther: he contended the only way to remedy this situation was
42                                                  No. 20-2946

to give him his own cell with his own toilet, not just so that he
could use his walker while using the toilet, but so that he
could practice timed voiding. McDaniel’s proposed solution
constitutes a form of medical treatment for his incontinence.
This reasoning undermines McDaniel’s attempt to character-
ize this claim as an access issue.
       3. No Top Bunk
    McDaniel contended further that having a bed with a top
bunk failed to accommodate his disabilities. McDaniel had a
lower bunk. While he hit his head on the top bunk a few times
when getting into his bed, he has not offered evidence that the
top bunk prevented him from accessing programs or services.
To the extent the pain specialists believed McDaniel should
have had a bed without a top bunk, that decision was related
to decreasing the number of opportunities where McDaniel
might aggravate his pain. That rationale does not show a de-
nial of access to programs or services. A reasonable jury could
not find that the top bunk prevented or discouraged his par-
ticipation in prison activities.
    To summarize our conclusions under the Rehabilitation
Act and the ADA, McDaniel met his burden to defeat sum-
mary judgment on the theory that the Department of Correc-
tions failed to accommodate and was deliberately indifferent
to his disability-related needs when it denied him a cell in a
unit that would not require him to go up or down stairs for
routine activities. We reverse the district court’s grant of sum-
mary judgment on that claim. We affirm the court’s grant of
summary judgment on the other claims under those statutes.
No. 20-2946                                                   43

V. Eighth Amendment Claim Against Dr. Syed
    We turn now to McDaniel’s Eighth Amendment claim
against Dr. Syed, a physician at the Columbia Correctional In-
stitution. According to McDaniel, Dr. Syed expressed skepti-
cism toward him in their first interaction, saying he could not
“possibly have” all his diagnosed medical issues. Later, how-
ever, Dr. Syed referred McDaniel to the Waupun Memorial
Hospital pain clinic in response to his complaints. Dr. Syed
continued to treat McDaniel, prescribing new medications
when necessary and refusing others after concluding that
McDaniel was likely engaging in “attention-seeking and
drug-seeking behavior.” Dr. Syed did not alter the disability
restrictions in McDaniel’s file at any point.
    McDaniel contended that Dr. Syed was deliberately indif-
ferent to his medical needs in two ways: first, by failing to fol-
low medical recommendations of outside specialists, and sec-
ond, by failing to change his course of treatment when it was
not adequately treating McDaniel’s pain. Given the demand-
ing standard under the Eighth Amendment, a reasonable jury
could not find for McDaniel on either theory.
   A. Legal Standard
    The Eighth Amendment prohibits “cruel and unusual
punishment” of a prisoner. It is well established that a prison
official’s “deliberate indifference” to a prisoner’s “serious
medical needs” violates that mandate. Farmer, 

(internal quotation omitted); Perez v. Fenoglio, 

 (7th Cir. 2015). To support a claim of deliberate indiffer-
ence, McDaniel needed to offer evidence that (1) he had an
objectively serious medical condition, and (2) Dr. Syed acted
with deliberate indifference to that condition. See Petties v.
44                                                   No. 20-2946

Carter, 

 (7th Cir. 2016) (en banc). Dr. Syed
disputes only the second element.
    Deliberate indifference depends on the defendant’s “sub-
jective state of mind.” 

 The question is whether McDaniel
provided evidence to support a finding that Dr. Syed “actually
knew of and disregarded a substantial risk of harm.” 

 (em-
phasis in original); see also Farmer, 

 (“[T]he of-
ficial must both be aware of facts from which the inference
could be drawn that a substantial risk of serious harm exists,
and he must also draw the inference.”). Negligence or even
objective recklessness—the “fail[ure] to act in the face of an
unjustifiably high risk that is so obvious that it should be
known”—is not enough to satisfy that standard. Petties, 

 (emphasis in original).
    Under the Eighth Amendment, a medical professional
who has treated a prisoner “is entitled to deference in treat-
ment decisions unless no minimally competent professional
would have so responded under those circumstances.” Camp-
bell v. Kallas, 

 (7th Cir. 2019), quoting Sain v.
Wood, 

, 894–95 (7th Cir. 2008) (internal quotation
omitted). To violate the Eighth Amendment, a treatment de-
cision must be “such a substantial departure from accepted
professional judgment, practice, or standards, as to demon-
strate that the person responsible actually did not base the de-
cision on such a judgment.” Sain, 

, quoting Col-
lignon v. Milwaukee County, 

 (7th Cir. 1998).
Equally important, however, the “receipt of some medical care
does not automatically defeat a claim of deliberate indiffer-
ence if a fact finder could infer the treatment was ‘so blatantly
inappropriate as to evidence intentional mistreatment likely
to seriously aggravate’ a medical condition.” Edwards v.
No. 20-2946                                                      45

Snyder, 

 (7th Cir. 2007), quoting Snipes v. De-
Tella, 

 (7th Cir. 1996); see also Arnett v. Webster,

 (7th Cir. 2011) (“a prisoner [does not] need
to show that he was literally ignored”).
   B. Disagreement with Specialists
    McDaniel first asserts that Dr. Syed was deliberately indif-
ferent to his serious medical needs by acting contrary to the
recommendations of outside specialists. Deliberate indiffer-
ence can occur when a prison official acts contrary to the rec-
ommendations of specialists for non-medical reasons. See Pe-
rez, 

 (collecting cases). That is not what oc-
curred here. The undisputed evidence shows that Dr. Syed’s
actions were based on “his own legitimate medical judg-
ment[s].” 

; see Estate of Cole v. Fromm, 

(7th Cir. 1996) (“Mere differences of opinion among medical
personnel regarding a patient’s appropriate treatment do not
give rise to deliberate indifference.”). McDaniel has not of-
fered evidence that the care he received was “blatantly inap-
propriate” or that Dr. Syed’s decisions were “substantial de-
partures from accepted professional judgment, practice, or
standards.”
    Take the no-stairs issue first. Dr. Syed agreed to discon-
tinue McDaniel’s no-stairs restriction after a physical thera-
pist made that recommendation shortly after McDaniel ar-
rived at Columbia. McDaniel argues that by including certain
restrictions in the post-operative instructions (which pre-
ceded his transfer), the spinal surgeon effectively recom-
mended that he live in a unit that would not require him to
go up and down stairs routinely. McDaniel contended that a
reasonable jury could find that Dr. Syed was deliberately
46                                                  No. 20-2946

indifferent to his medical needs by acting against that sup-
posed recommendation.
     There are several problems with this argument. First, it is
not clear that the post-operative instructions support McDan-
iel’s position. He points to the instruction that said he should
lift no more than five to ten pounds. McDaniel asserted under
penalty of perjury that his walker weighed twenty-five
pounds (recall it had four wheels and an attached chair). But
for this argument to have traction, Dr. Syed would have
needed to have been aware of that weight and to have under-
stood that McDaniel needed to use the walker to go up and
down stairs, requiring him to lift more than ten pounds each
time. (Recall that as part of the evaluation, the physical thera-
pist had McDaniel walk up and down six stairs without the
aid of a walker, which he did successfully. Dr. Syed consulted
these notes in changing McDaniel’s restrictions.) Putting
those evidentiary holes aside, the post-operative instructions
also said that McDaniel may “climb stairs.” A reasonable jury
could not find that Dr. Syed acted with deliberate indifference
to McDaniel’s serious medical needs by agreeing with the spi-
nal surgeon’s suggestion that McDaniel could “climb stairs.”
    Next, consider the recommendation by the outside pain
specialist that McDaniel live in a cell without a top bunk.
McDaniel contends that the top bunk exacerbated his pain be-
cause he would often hit his head on the bunk due to his lim-
ited mobility in his back and that his cellmate would some-
times hit him getting in and out of bed. When McDaniel com-
plained of these issues to the Health Services Unit, staff mem-
bers were not able to corroborate his complaints. Dr. Syed as-
sessed McDaniel’s condition and did not believe that a no-
top-bunk restriction was medically necessary. McDaniel has
No. 20-2946                                                    47

not offered evidence that Dr. Syed’s conclusion was a substan-
tial departure from acceptable professional standards, even if
it did conflict with the outside pain specialist’s recommenda-
tion. Holloway v. Delaware County Sheriff, 

(7th Cir. 2012) (“[T]he prison physician, as the [prisoner’s] act-
ing primary care doctor, is free to make his own, independent
medical determination as to the necessity of certain treat-
ments or medications, so long as the determination is based
on the physician’s professional judgment and does not go
against accepted professional standards.”).
    Finally, McDaniel points to the recommendation by the
nephrologist that he live in a single-occupancy wet cell to aid
in his timed voiding. At an appointment a few months into his
stay at Columbia, McDaniel told Dr. Syed that he had issues
with “fecal incontinence” and that he had “problems [with]
cell[mate] when defecating.” Dr. Syed did not change McDan-
iel’s cell assignment. Then, a nephrologist visited McDaniel
twice and concluded that a single-occupancy wet cell would
help treat his incontinence issues. Dr. Syed, however, contin-
ued the same course of treatment: diapers and a double-occu-
pancy cell with a toilet. Other Health Services staff agreed
with Dr. Syed that McDaniel’s cell assignment did not need to
change.
   McDaniel has again failed to introduce a disputed fact that
Dr. Syed’s decision was devoid of medical judgment or to
show that the prison was required to adopt the nephrologist’s
recommendation. Deliberate indifference is a demanding
standard, and McDaniel did not offer evidence that Dr. Syed’s
decision to keep his treatment the same was a substantial de-
parture from acceptable professional standards. Snipes, 

 (“[T]he Constitution is not a medical code that
48                                                   No. 20-2946

mandates specific medical treatment.”). The recommenda-
tions by the nephrologist do not support such a conclusion on
their own. See Reck v. Wexford Health Sources, Inc., 

,
484–85 (7th Cir. 2022) (disagreement among physicians did
not, without more, establish reckless disregard for patient
harm and pain required for constitutional violation).
     C. Pain Treatment
    McDaniel also asserted that a reasonable jury could find
that Dr. Syed was deliberately indifferent to his pain. We dis-
agree. “[T]he Eighth Amendment does not entitle incarcer-
ated patients to their preferred pain medication, nor does it
impose the unrealistic requirement that doctors keep patients
completely pain-free.” Arce v. Wexford Health Sources Inc., 

 (7th Cir. 2023) (internal citations omitted).
    In response to McDaniel’s complaints of pain early in his
stay at the Columbia Correctional Institution, Dr. Syed re-
ferred him to the Waupun Memorial Hospital pain clinic. He
also prescribed McDaniel new medications to help address
his pain. Later, Dr. Syed assessed McDaniel, concluded that
he was likely engaging in “attention-seeking and drug-seek-
ing behavior,” and refused to change his medications. Dr.
Syed said that his conclusion was based on his medical assess-
ment, a past cardiac work-up, and how McDaniel presented
himself during their interaction. “The administration of pain
killers requires medical expertise and judgment. Using them
entails risks that doctors must consider in light of the bene-
fits.” Snipes, 

.
   McDaniel has again not offered evidence that Dr. Syed’s
decision constituted a substantial departure from acceptable
professional standards or that the treatment he did receive
No. 20-2946                                                  49

was “‘so blatantly inappropriate as to evidence intentional
mistreatment likely to seriously aggravate’ his condition.”
Greeno v. Daley, 

 (7th Cir. 2005), quoting
Snipes, 

; see also Lee v. Young, 

(7th Cir. 2008) (“Prison officials are expected to act responsi-
bly under the circumstances that confront them but are not
required to act flawlessly.” (internal quotation omitted)). That
strikes us as especially true when other staff members in the
Health Services Unit came to similar conclusions regarding
McDaniel’s care. Cf. Pyles v. Fahim, 

 (7th Cir.
2014) (doctor not deliberately indifferent when decision to
forgo MRI was “implicitly endorsed by every other doctor
who examined [the plaintiff]”).
                        *      *      *
    The district court’s grant of summary judgment for the De-
partment on McDaniel’s ADA and Rehabilitation Act failure-
to-accommodate claim based on the denial of a no-stairs unit
at the Columbia Correctional Institution is REVERSED. In all
other respects the judgment of the district court is
AFFIRMED, and the case is REMANDED for proceedings
consistent with this opinion.
50                                                  No. 20-2946

     BRENNAN, Circuit Judge, concurring in part and dissenting
in part. My colleagues and I agree that the defendants are en-
titled to summary judgment on most of Carl McDaniel’s case.
We part ways on his claim under Section 504 of the Rehabili-
tation Act, as applied to the denial of his placement in a no-
stair unit during his incarceration at Columbia Correctional
Institution. Because review is limited to the evidence that was
properly before the district court, I would affirm the district
court’s grant of summary judgment to the defendants in full.
    The district court correctly concluded that McDaniel’s
submissions disregarded the local rules. McDaniel did not
even try to identify the evidence on which he now relies for
his claim to be housed in a no-stair unit. The district court de-
clined to scour the record. Instead, it considered McDaniel’s
responses to the defendants’ proposed facts and his own pro-
posed facts only when they complied with the local rules.
That decision was a matter within the district court’s sound
discretion.
                                I
     A. Civil Local Rule 56 – Summary Judgment
    Under our case law, district courts have broad discretion
to compel compliance with their local rules governing sum-
mary judgment proceedings. These rules serve a crucial func-
tion for district judges, who face the difficult task of managing
and prioritizing hundreds of cases and thousands of motions.
In particular, the local rules on summary judgment require a
party to direct the judge to the portions of the record that sup-
port the party’s factual assertions or its opposition to those of
its counterparty. Hinterberger v. City of Indianapolis, 

 (7th Cir. 2020). “The rules of each district court
No. 20-2946                                                                51

structuring the summary-judgment process cannot serve their
function if parties can later go to the court of appeals and se-
cure a reversal based on evidence the district judge may not
have known was present.” Johnson v. Cambridge Indus., Inc.,

 (7th Cir. 2003).
    In the Eastern District of Wisconsin, a party moving for
summary judgment must file a statement of proposed mate-
rial facts. Civil Local Rule 56(b)(1)(C). Each fact must be con-
tained within its own separate, numbered paragraph. 

 The
party opposing summary judgment must reproduce each
numbered paragraph in the moving party’s statement. Civil
Local Rule 56(b)(2)(B). For any disagreement, the nonmovant
must submit “specific references to the affidavits, declara-
tions, parts of the record, and other supporting materials re-
lied upon.” 

 The nonmoving party also must file “a state-
ment, consisting of short numbered paragraphs, of any addi-
tional facts that require the denial of summary judgment, in-
cluding references to the affidavits, declarations, parts of the
record, and other supporting materials relied upon to support
the facts described in that paragraph.” Civil Local Rule
56(b)(2)(B). 1
    Time and again, we have recognized that district courts
“may require strict compliance with their local rules.” Hinter-
berger, 

; see also Ammons v. Aramark Unif. Servs.,

    1 The current iteration of Civil Local Rule 56 has been in effect since

2010. This court has upheld the enforcement of earlier versions of the rule,
which date back decades. See Huey v. United Parcel Serv., Inc., 

 (7th Cir. 1999) (upholding then-Civil Local Rule 6.05, which required
the submission of specific evidentiary materials to dispute particular facts
at summary judgment); Kunik v. Racine Cnty., Wis., 

(7th Cir. 1997) (same).
52                                                  No. 20-2946

Inc., 

 (7th Cir. 2004). When a district court
decides that a litigant has violated those rules, we review that
decision solely for abuse of discretion. Cichon v. Exelon Gener-
ation Co., 

, 808–09 (7th Cir. 2005) (considering
Northern District of Illinois Local Rule 56.1, closely analogous
to the Eastern District of Wisconsin local rule here). And we
have repeatedly stressed that district courts may decline to
consider the noncompliant portions of submissions. “[A]
court does not abuse its discretion when it opts to disregard
facts presented in a manner inconsistent with the rules.” Fab-
riko Acquisition Corp. v. Prokos, 

, 607–08 (7th Cir.
2008) (upholding district court decision under predecessor
E.D. of Wis. Civil Local Rule 56.2(b) to limit factual record
when litigant failed to specify citations to evidentiary materi-
als).
    Contrary to McDaniel’s arguments, requiring adherence
to local rules is not empty formalism. Rather, it is essential to
the proper functioning of the district courts. Johnson, 

. In our adversarial system of litigation, the parties have
the duty to identify “what facts are truly disputed and may
require resolution at a trial.” Hinterberger, 

. A
district court has no such duty. 

     B. McDaniel’s Noncompliance
    The defendants followed the local rule by submitting a 93-
paragraph statement of proposed material facts. McDaniel’s
responses to those proposed facts failed to comply with the
local rule. Few, if any, of McDaniel’s responses cited affida-
vits, declarations, or specific portions of the record. Many re-
sponses contain no citation, while some list a vague authority
such as “policy.” That falls short under our case law. See
McKinney v. Off. of Sheriff of Whitley Cnty., 

, 808–
No. 20-2946                                                    53

09 (7th Cir. 2017); Ammons, 368 F.3d at 817–18 (stating that a
denial “must include a specific reference to the affidavit or
other part of the record. … Citations to an entire transcript of
a deposition or to a lengthy exhibit are not specific and are,
accordingly, inappropriate.”).
    Even in the few places where McDaniel’s responses ap-
pear to reference specific documents, the responses do not tell
the district court where to find those documents. Several of
McDaniel’s responses also improperly contain legal argu-
ments. Many times, we have held that such responses violate
local rules on summary judgment. See Hinterberger, 966 F.3d
at 528–29; Curtis v. Costco Wholesale Corp., 

(7th Cir. 2015); FTC v. Bay Area Bus. Council, Inc., 

,
634 (7th Cir. 2005); Smith v. Lamz, 

 (7th Cir.
2003); Bordelon v. Chicago Sch. Reform Bd. of Trs., 

,
528–29 (7th Cir. 2000).
    McDaniel’s statement of additional material facts was also
deficient. His submission includes some citations to docu-
ments in the record, but for the most part it does not contain
facts, and instead quotes legal arguments made in the parties’
briefs.
    McDaniel points to two cases to argue that the district
court should excuse his noncompliance, but neither is analo-
gous. In Sojka v. Bovis Lend Lease, Inc., 

 (7th Cir.
2012), it was an abuse of discretion for the district court to re-
fuse to consider evidence just because it was included in the
nonmovant’s statement of material facts but not in his accom-
panying memorandum of law. 

. There, the non-
movant “did not make the district court scour the record; he
followed [the local rule] … and brought to the district court’s
attention the evidence in the record supporting his opposition
54                                                  No. 20-2946

to summary judgment.” 

. Here, though, McDaniel
would have the district court search the record, and he did not
follow Civil Local Rule 56(b)(2)(B). Sojka therefore does not
help McDaniel.
    Likewise, in McKinney, this court ruled that a district court
abused its discretion by disregarding the “specific guidance”
as to pertinent record evidence that the nonmovant provided
at summary judgment. 

. There, the nonmovant
provided the district court with “a detailed and organized
guide to [the] evidence supporting his assertions of disputed
facts and his legal arguments.” 

. McDaniel provided
no such detailed and organized guide, so the district court
was within its discretion to disregard evidence that was not
identified in compliance with the local rule.
    Per McDaniel, the district court lacked discretion to en-
force the local rule against him for two other reasons. The first
is that McDaniel represented himself before the district court.
The second concerns the district court permitting him to re-
spond to the defendants’ statement of material facts by sub-
mitting an affidavit or unsworn declaration.
    Neither reason is persuasive. First, given the procedural
history here, McDaniel was not entitled to special solicitude
because he litigated pro se. The district court recruited an ex-
perienced, knowledgeable attorney to assist McDaniel with
prosecuting his claims. But McDaniel became dissatisfied
with his attorney’s legal strategy, and he asked the court to
terminate his services. The attorney therefore withdrew.
McDaniel chose to litigate pro se, so he cannot use that status
to claim an entitlement to disregard the district court’s local
rules. In any event, pro se litigants are not excused from com-
plying with procedural rules, Pearle Vision, Inc. v. Romm, 541
No. 20-2946                                                    

 (7th Cir. 2008), or court orders. DJM Logistics,
Inc. v. FedEx Ground Package Sys., Inc., 

 (7th
Cir. 2022). That principle applies to rules governing summary
judgment. Zoretic v. Darge, 

 (7th Cir. 2016)
(citing Greer v. Bd. of Educ., 

, 727 (7th Cir. 2001)).
    Second, the district court did not coax McDaniel into non-
compliance with Civil Local Rule 56. To the contrary, the
court advised him in a plain language Notice and Order that
he “must support every disagreement with a proposed fact by
citing to evidence.” As McDaniel notes, the court allowed him
to do so “by relying on documents that he attaches to his re-
sponse or by telling the court his version of what happened in
an affidavit or an unsworn declaration under 

.” But nothing in the court’s Notice and Order excused
McDaniel from providing “a detailed and organized guide to
[the] evidence supporting his assertions of disputed facts and
his legal arguments.” McKinney, 

. McDaniel did
not meet that standard. So, the district court was within its
discretion to decide the summary judgment motion without
first sifting through this case’s extensive record to try to locate
and examine evidence that McDaniel failed to identify or re-
spond to.
   C. The Majority Opinion’s View of the Facts
    My colleagues conclude that the district court went too far
with respect to one fact—that McDaniel missed meals because
he was not assigned to a no-stairs unit. Because McDaniel
signed all his summary judgment submissions under penalty
of perjury, the majority opinion concludes that they provide
a factual record that satisfies the applicable federal and local
rules. Then the majority opinion pulls statements about the
56                                                             No. 20-2946

meals missed from McDaniel’s submissions, citing them as
the evidence that survives summary judgment.
    On review, though, the selected quotes from McDaniel’s
filings repeated in the majority opinion do not qualify as facts
defeating summary judgment. All but one relate to claims dif-
ferent than his placement in a no-stairs unit. 2 The only state-
ment the majority opinion cites that is connected to McDan-
iel’s Rehabilitation Act claim 3 still violates Civil Local Rule
56(b)(2)(B) by failing to be a concise response to the movant’s
statement of facts that specifies references to the record relied
upon.


     2 McDaniel’s statement that he was “missing [h]undreds of state

meals” is in R. 178 ¶ 46, his response to defendants’ proposed findings of
fact concerning his claim not to have a top bunk.
    McDaniel’s statement that the prison “denied [me] over 600 state
meals” is in R. 179, his response to the declaration of Dr. Salam Syed, who
played no role in McDaniel’s ADA/Rehabilitation Act claim. This state-
ment was in response to ¶ 26 of Dr. Syed’s declaration about McDaniel’s
medications, not his request to be assigned to a no-stairs unit.
     And McDaniel’s statements that he “missed over 600 state meals in
less than a year because of severe pain” and “Defendants were all aware
of the ongoing constitutional violations of the [o]ver 600 … state meals”
are from R. 177, his “Reply to Defense Argument,” at pp. 10 and 12 of that
filing, in its section concerning his conditions of confinement claim, not
his Rehabilitation Act claim.
     3 McDaniel’s statement that “[m]issing over 600 state meals because

of severe unrelenting pain and being fed by modifying a program, which
defendants never did, is not a comfort consideration, it is a “Life-Giving”
requirement of the defendants” is from R. 177, his “Reply to Defense Ar-
gument,” at p. 10 of that filing, in its section concerning his Rehabilitation
Act claim.
No. 20-2946                                                    57

    The irony, of course, is that by not upholding the local
rule, we are left performing the very task that rule is supposed
to preclude—combing the record for statements and consid-
ering them as evidence on a dispositive motion.
    A district court cannot ignore facts brought to its attention.
But under the federal and local rules, parties must properly
present the factual record for the court to resolve a summary
judgment motion. This sorting function of parties identifying
evidence for the court on a dispositive motion is critical. It
forms the backbone of all the case law discussed above. It is
not overly formalistic to ask that this requirement be com-
plied with, something McDaniel failed to do. He certainly did
not provide “a detailed and organized guide to [the] evidence
supporting his assertions of disputed facts and his legal argu-
ments,” McKinney, 

, as this court requires.
    My colleagues conclude that the declarations McDaniel
added to each of his submissions rendered his missing-meals
statement admissible evidence that precludes summary judg-
ment on his no-stairs claim. Yet that conclusion fails to recog-
nize the sorting function of the local rule. That rule’s point is
to focus the district court and the litigants on admissible evi-
dence pertinent to the dispositive motion. If declarations can
bootstrap into evidence all of a pro se litigant’s submissions,
the local rule is undermined.
    Unlike my colleagues, I do not see the district court mis-
apprehending that his declaration must itself incorporate af-
fidavits, or that court failing to appreciate that McDaniel
could rely on his own declaration. If the court did believe ei-
ther of those things, it would not have worded the Notice and
Order in the disjunctive:
58                                                    No. 20-2946

       McDaniel must support every disagreement
       with a proposed fact by citing to evidence. He
       can do that by relying on documents that he at-
       taches to his response or by telling the court his
       version of what happened in an affidavit or an
       unsworn declaration … .
(emphasis supplied).
    The majority opinion also criticizes the district court for
holding McDaniel to an “unwritten requirement” by consid-
ering his submissions only to the extent they complied with
the local rule. But this critique shifts from the litigant to the
court the local rule’s requirement to enumerate the applicable
evidence. To demand more from the district court—per the
majority, to “specify[] further the failures or the affected por-
tions of plaintiff’s submissions”—reads into the local rule an
obligation that is not there. Failing to take a step that the local
rule does not call for is not an abuse of discretion.
    Beyond McDaniel’s failure to affirmatively offer evidence
to defeat summary judgment, he also failed to adequately
contest several proposed factual findings which doom the no-
stair-unit theory of his Rehabilitation Act claim. Most perti-
nent are three findings proposed by the defendants:
       •   A physical therapist at Columbia evaluated
           McDaniel’s mobility in January 2018. During
           that assessment, McDaniel managed to as-
           cend and descend six stairs, and the physical
           therapist decided he was safe to ambulate
           stairs. McDaniel agreed with that finding,
           though he argued that the physical therapist
           did not sufficiently account for safety.
No. 20-2946                                                   59

       •   Michael Fink, a Corrections Unit Supervisor
           at Columbia, observed McDaniel success-
           fully climbing the stairs more than once to
           report concerns. Again, McDaniel agreed
           this was true. His response referenced “the
           multiple times [he] did have to use stairs.”
       •   McDaniel was “encouraged to get out of his
           cell for meals and use his cane for the stairs
           because muscle atrophy from lack of move-
           ment could result in the inability to walk in
           the future.” For support, the defendants
           cited the declaration of Dr. Syed, a physician
           at Columbia who oversaw McDaniel’s treat-
           ment and evaluated him several times.
           McDaniel failed to even acknowledge this
           proposed finding, declining to offer any re-
           sponse.
Because McDaniel did not competently dispute any of these
facts, the district court was within its discretion to treat them
as admitted. See Fabriko Acquisition Corp., 536 F.3d at 607–08;
Cichon, 401 F.3d at 809–10.
                               II
    I turn now to the substance of McDaniel’s claim under Sec-
tion 504 of the Rehabilitation Act. By the statute’s terms, “[n]o
otherwise qualified individual with a disability … shall,
solely by reason of her or his disability, be excluded from the
participation in, be denied the benefits of, or be subjected to
discrimination under any program or activity receiving Fed-
eral financial assistance.” 

(a). The analysis is
the same that applies to a claim under the Americans with
60                                                   No. 20-2946

Disabilities Act (“ADA”). Jaros v. Ill. Dep’t of Corr., 

 (7th Cir. 2012). To recover, McDaniel must prove that
“(1) he is a qualified person (2) with a disability and (3) the
Department of Corrections denied him access to a program or
activity because of his disability.” 

.
    The dispute here is over the third element—whether
McDaniel was denied access to a program or activity because
of his disability. The meals that prisons make available to in-
mates qualify as programs or activities under the statute. 

So, the question is whether a reasonable jury could find that
McDaniel was denied access to meals. Under Section 504, re-
fusing to make reasonable accommodations amounts to deny-
ing access, 

 but only when the result is that the qualified
person cannot access programs or activities at all. Wagoner v.
Lemmon, 

 (7th Cir. 2015); see also Hildreth v.
Butler, 

 (7th Cir. 2020) (applying this principle
in the identical ADA context). A prison’s institutional prerog-
atives factor into whether an accommodation is considered
reasonable. Hildreth, 

 (citing Love v. Westville
Corr. Ctr., 

 (7th Cir. 1996)).
    Considering only the facts properly before the district
court, it knew that both the physical therapist and Fink ob-
served McDaniel safely ambulate stairs. The court also knew
that McDaniel was given a rationale, which was based on
medical judgment, for why his placement in a no-stair unit
would not have been benefited his long-term health. Taken
together, these facts show the absence of a genuine dispute of
material fact as to whether McDaniel required a no-stair unit
to access meals. The burden therefore shifts to McDaniel, the
nonmoving party, to provide evidence of specific facts creat-
ing a genuine dispute of material fact and thus precluding
No. 20-2946                                                    61

summary judgment. See Cincinnati Life Ins. Co. v. Beyrer, 

 (7th Cir. 2013); Carroll v. Lynch, 

(7th Cir. 2012).
    Under the facts as described supra section I, McDaniel did
not cite any such evidence to the district court. On appeal, he
relies on two portions of his deposition testimony. In the first,
McDaniel testified he did not attend programs and activities
at Columbia because it was “too painful” for him to walk up
the stairs. And in the second, McDaniel stated he could not
get up and down the stairs without assistance from other in-
mates.
    Before the district court, though, McDaniel did not iden-
tify these passages. They are not mentioned in his responses
to the defendants’ proposed findings of fact, his own state-
ment of undisputed facts, or his summary judgment brief.
McDaniel did not even cite his deposition more generally,
though that would have been insufficient. See McKinney, 866
F.3d at 808–09; Ammons, 368 F.3d at 817–18. Only by
“scour[ing] the record,” Sojka, 

, and “doing the
work for” McDaniel by “identifying what facts [were] truly
disputed,” Hinterberger, 

, could the district
court have located these portions of his deposition and ana-
lyzed their import. As noted earlier, that goes beyond what is
required of district courts and of this court on appeal.
    As discussed above, McDaniel was observed successfully
using the stairs at Columbia more than once. Placement in a
no-stair unit also would have been contrary to the medical
judgment of trained professionals. The other accommoda-
tions McDaniel was given, including the cane that he was di-
rected to use when climbing stairs, were reasonable because
they permitted him to access meals and activities while also
62                                                  No. 20-2946

accounting for other considerations. See Hildreth, 

 (reaching this conclusion about a different accommoda-
tion in the prison context).
   These facts make the disposition of the no-stair theory of
McDaniel’s Rehabilitation Act claim straightforward. Recall
that to recover, McDaniel has to prove that a no-stair unit was
a reasonable accommodation, the absence of which denied
him access to programs or activities. Jaros, 

. The
refusal to adopt a specific accommodation requested by a
prisoner is not a denial of access unless the prisoner cannot
use the program or participate in the activity. Wagoner, 

. This is so even if the requested accommodation
would significantly ease the inconvenience to the prisoner. 

                        *      *       *
    Based on the facts properly before the district court, place-
ment in a no-stair unit would not have been necessary for
McDaniel to get his meals because he could safely use the
stairs. No reasonable jury could conclude that the Wisconsin
Department of Corrections violated the Rehabilitation Act
when it declined to place McDaniel in a no-stair unit. I there-
fore respectfully concur in part and dissent in part.