this circuit the st issue is whether it is clearly a stablished in this circuit that the th amendment requires prison officials to p policies for specific medical decisions based on certain symptoms that may be presented to medical licensed medical professionals or whether or  whether it's the case that prison officials may be delegate there is decisions to the licensed medical professionals rather than promulgating specific policies in that regard the  clearly established question is whether it is clearly established under the th amendment that prison officials must probably policies and procedures outlining the specific circumstances in which a patient's medical condition renders then renders them unable to voluntarily waive treatment or whether prison officials can simply rely on the medical medical professionals that they've hired to make those determinations the rd question has has to do with employing physicians whether it's clearly established in this circuit under the th amendment that prison officials may not employ licensed medical professionals who have had past discipline  professionals that are not before the court today to immediately inform a physician or refer an inmate to a hospital when an inmate presents complaints about difficulty breathing or acute stomach pain or showed obvious signs of medical distress like a racing heart or other symptoms that are commonly associated with acute appendicitis or that would require a physician including dependent balewa to policy that lays out all those things what was the policy the the policy is not alleging a complaint we're hearing a motion to dismiss i something like that and those are policies promulgated by the medical director not by a person in the position of my clients who is that the director of the department corrections that the top person and the warden of the strictly you're correct it is strictly a supervisor reliability case and specifically it's a supervisor supervisory liability case alleging unconstitutional hiring and these two policies that nor the district court cited any cases showing that would put defendants who are in the position of my clients on on notice that it was beyond debate that they would be by leading the th amendment if they did not put these specific policies in place the plane does not allege anywhere in the complaint that these policies caused any specific investigators had identified recurring issues with the jail's medical care over a period of years there are simply no such allegations here of any specific medical problems other than the conclusion the allegations that i mentioned a moment ago the next case because the sheriff himself directed the jailer by telephone not to take the plaintiff to the hospital because he was still conscious there's no specific allegation in our case that my client's did anything hands on or made any emitted that he was aware of prior incident where a male nurse had been watching a juvenile female inmate in the shower of the medical unit and he conceded that better monitoring who could just discouraged ciar incidents he was on notice of those that problem but he had not made any changes to the manner in which juvenile female inmates were surprised that case doesn't clearly estab judge kelly is correct this is an appeal concerns to a supervisor and reliability issue and in this case the district court judge gunn when issued a very thorough twenty two page decision been doing and what the director of corrections over the high entire state did or should have done to subject them to liability as opposed to the people down on the ground yes absolutely to tell you the what the complaint alleges are a number of specific failures by these two defendants one the complaint alleges the defendant all about and defendant there were responsible for onsite medical care and that in that capacity they had a policy within our monotonous prison of hiring incompetent unprofessional and ill qualified providers two of whom provided care to our to mr joshua responsibility for hiring onsite medical personnel for managing and for supervising them and we set up was that he admitted well your honor the motion to dismiss was filed and that is an important element of this case we are the motion to dismiss stage and judge goodwin found that we had multiple specific allegations against these two defendants we identified five specific policies that they were responsible for either implementing our failure to implement we've identified a pattern within the oklahoma department of corrections of hiring ill qualified and grossly incompetent medical staff as of two thousand and twelve apparently one rd of the doctors employed by the department of corrections have been subjected to discipline and so for several pages in our complaint with the allegations of which obviously must be taken while pleaded in plaintiff's favor at this stage judge good went on that we had specifically alleged what these two defend there anything to show that the warden or the secretary corrections was aware of prior malpractise or inadequate treatment by either of the doctors your honor there is nothing to show that yet and that is dollars of our complaint which to specifically set out that these dips in the defendants were responsible for improperly hiring supervising and retaining the defendants on staff but they were aware that there was a number of medical providers system and it shows a part who were not qualified that they were aware that there was a culture of constitutional disregard it actually was a part that they were aware that the oklahoma department of corrections was a sinking ship where defendant how i was aware of serious problems jeopardizing the health and safety of those it inside shows apart and he quotes just specific statements in the public record that to an albino had made about the inability of the department of corrections to provide for the prison population in a safe and humane way and predicting that that failure was going to lead to lawsuits against the department now that at the pleading stage certainly close to defendant al moves the court fine as your honor is pointing out that the allegations cannot be conclusory here we've identified two specific medical providers and an allegation about the overall problem with the quality of doctors that are responsible joseph parker and took no steps to correct it and your honor what i would say is is there if the question that these the decisions of this court look at is is there fair notice to these allegations go beyond formulate labels and conclusions place and these are not policy specifics to any particular condition your honor these are the very basic policies regarding when does somebody have to go to the hospital when does somebody require in person examination when does somebody in a medical the show whatever just to the governor i mean what you what did you just through the whole state government while they know just as much is as the secretary of corrections you know your honor with all due respect there definitely are cases where an individual at this at this level of government is not the proper defendant and for example there are cases where you know the secretary of new mexico corrections the town not to be the proper person in a case about an individual incident but in this case at the motion to dismiss stage where we have laid out the people involved the policies involved you haven't laid or know anything about what the individual did the sceptically with respect to what you're saying should have been done i've been nothing there we have laid out the basis for our belief that these defendants were responsible and that specifically is that this was their job to oversee the medical sectarian and that be events that unfolded here combined with the allegations about it general failure to have qualified staff on duty and with the allegations about  talk about defendant all about role in this your honor we do specifically allege that he was aware of the serious problems jeopardizing people's health and safety and we quote is publicly available state and you will learn issue based on that to whether these officers of these supervisors implemented the policies properly not whether they were involved in a specific case thank you very much thank you counsel peterson i think you have a minute and a half or so