was injured severely in a riot and sustained injuries to his hand and wrist he requested medical care from deputies at the facility that night but was denied medical care after that point in time he repeatedly requested medical care but he was not x rayed even though he told them that its hands were broken for over a week after that nobody reviewed the x rays for at least two weeks and he didn't receive surgery on his hand for at least a month as a result he sustained permanent injuries to his hand that will cause him intermittent pain and limited range of motion for the rest of his life mr prince filed a lawsuit naming the two deputies and the sheriff in charge of the facility and the defendants in response move for s judgment with respect to his claims regarding medical attention they did not move with respect to an equal protection claim they brought while the district court concluded that mr prince's claims were serious as a matter of law detainees not equal claims court seem to reference eight amendments delivered a different standard but then include language and since that is the minimum yes but i don't think i've seen a case perhaps you have which efficient establish a violation so it's not necessary to establish deliberate it difference now it's true that the cases don't go into a lot of detail about what that lesser standard is there are a couple options available to the court one it seems to me that just a requirement a punishment indicates that you don't need to undertake an inquiry into the intent of the actors if it's sufficient the punishment is established then that should be sufficient without going into what they believe subjectively or objectively another possibility is instead of a recklessness type the standard for deliberate indifference maybe negligence or strict liability standard is sufficient in cases of pre detainees looking at the time frames and it's what we're looking at is the request for manically tension in the evening and then no one doing anything until the next day correct while the phase one that's phase one and all that was done the next day was he saw a nurse but he wasn't given any x rays even though he told them his hand was broken and it was swollen right but he so in terms of the individuals because you have the two guards that are in the evening so you have that time frame yes ok is he also alleging i claimed from that point  correct that the and the failure to send him to the hospital immediately that night was attributable to the deputies and also to the sheriff's failure to supervise the deputy but then she also alleged in his complaint on and it's in the record on page two of the appendix that the sheriff was responsible for medical care at the facility and so he as a pro se prisoner is entitled to the benefit of the doubt in his pleadings and has made an allegation that the sheriff was responsible for medical care at the facility and that he didn't get adequate medical care and there's a whole series of instances after that where it was not just that somebody made a mistake it was that there was that it wasn't alleged policy that we would be looking at in terms of county policy and then the second thing if the levee is the issue which seems to be his primary his complaint like some medical people looked at this and didn't really figure out what it was for quite a while well i don't think in different forms that's not really correct your honor first there were no x rays taken for a week so nobody was looking at anything they didn't do the test that was required to you can be able to look at it and then after that there's a and that the x rays occurred on september twenty second the right was on september thirteenth september twenty ninth was the first time anybody looked at it the district court said it was unclear who was looking at these x rays i know that the defendants maintained that there was official physicians who did look at them and concluded that there wasn't a problem and then after that then the surgery occurred later on after they diagnosed are those about a month later so really we're talking about say went to the judgment yourself and identified as phase one right that's the time frame and the composite the district court is troubling on this record is that if you if you do say look nobody else even trained medical personnel really couldn't identify these injuries then what how how can how can we apply a liability refuse liability to these deputies for failing to observe and say swan well we know who could have identified the injuries and that was the physicians who ultimately diagnosed them at the hospital and had the deputy sent them to him to the hospital it's likely and he's entitled to the you kind of go down the road and it turns out that in the end he needs some surgery but it's a long ways from saying that the fact that he got looked at by a nurse that morning is the reason that he needed the hospital well that was that another different tension facility that wasn't at the u s c s t hospital he when he went to the u c s d hospital he was diagnosed and that's where he could have been taken you know night of the riots but because of the deputy's actions he wasn't with respect to the medical personnel it's not that they were making mistakes and necessarily it's that they didn't apparently have you know they didn't have a physician there to look at the x rays for two weeks i didn't happen until two weeks later that's not and matter of having somebody there who's just incompetent it's a matter of they apparently weren't available to look at the x rays and that did cause the way that contributed to his injury law doesn't say that it needs to be a major contributor to the injury or substantial contributor under the mcguckin case that that line was rejected and so there is a link here maybe it's not the primary reason for permanent injury you know each of these individual factions but they did contribute to it and so therefore they can be held liable in summary judgment would be inappropriate with respect to them your times  it's correct for us to look precisely at how it's been characterized this morning phase one what happened during phase one those twelve hours before prince was actually seen and cicotte and in this regard the district court's order of summary judgment should be affirmed because prince has not raised a genuine issue on the trail fact that the twelve hour wait before sick call harmed him at all is it isn't the rather isn't the inquiry whether or not there is a disputed issue of fact as to whether he appeared to have some injury that required reference in other words where these injuries appeared to be significant and that a referral to him that the medical facilities might have been warranted yes certainly is there a disputed issue threats about the appearance of the entries in your judgment yes there is there is a well i'm sorry state of that there is not i don't believe on the trail fact with regard to how his injuries appeared yes yes he's or to the nursing staff the next morning and that's because the nursing staff just twelve hours later documented how princes hand appear it was not read for the truth there was no or there was some slight swelling on the dorsal aspect of it and some limited range of motion due to pain and nothing else and that's why the nurse concluded that it was not an emergency situation that she could administer over the counter medication for it was to use ice and elevate the hand and that's what she did so when you're looking at what the deputies were observing the night before they other difficulty but that we have to take as a given because that's what he says so if someone says you have a broken right hand and you go to the hospital and the deput says you know i'm not a nurse you had your chance how do we evaluate those facts because it's seems that it's not disputed those things took place the case to dispute it correct so saying that's true well assuming that's true that's certainly not commendable conduct on the part of the deputies in terms of what they may have said or even what they may have failed to do in terms of responding to prince's complaint if in fact that's what he said he said multiple things at different times in terms of how we communicated with the deputies but the district court did find primarily based i think on what the nursing staff failed  when they observe the injury the next morning that there was insufficient information despite whatever comments were made or whatever self diagnosis was offered by press there was insufficient information for the deputies to actually draw an inference that he was at risk for substantial injury if he did not receive immediate medical care what is what is the standard we should be looking at in your view i know it's murky depending on how you read the cases but at least  detainees and criminal detainees who are in need of restored of treatment and those are the decisions that come out of jealously blas and organs the unique those though do not apply in this case it would be quite a leap for us to presume punishment based on language from jail condition cases when we're actually instructed under a veil and farmer to something something else involved because it's a fourteen to now rather than eighteen and i can and if you have a case where you can't resolve it on television and difference i'm at our loss as to what standard we really ought to apply well we have not brief that and i think that's a very complicated financial question i think that the district court though in her opinion recognized the problem and the comments from the low vacate that also recognized the problem and dealt with it by assuming what conduct would be required of the deputies had they been held to the highest standard and the highest standard would require them to simply take mr prince at face value targets of how he looks regard for the factors no protruding bones no significant swelling no redness no bruising no blood despite that if he said i need to go to the hospital they're supposed to simply drop everything i guess and take him there but val i don't think it's the standard and the district court judge determined that even if it had been it wouldn't have made a difference because he would have been taken to the dispensary where all of the injured inmates were taken following the disturbance at the jail for evaluation by the repeat physicians examinations the fact that prince was seen every two to three days in response to every single sick call request and the doctors and the nurses did not find evidence of a broken hand or even a serious injury at prince's request dr win over the bailey detention facility went ahead and ordered an x ray and that x ray was done a couple of days later on september twenty two it was the results were sent out to diagnostic laboratories which is reflected at se are seventy eight they were interpreted by the radiologist dr paul corey who immediately faxed back the result to george bailey that same day and that is indicated the top of the page where the fax transmittal information is located as well as the bottom of the page where there's an indication it was received by bailey on september twenty two the same day the se are regarding the medical entries for that day show the nurse looked at those results that day saw they were negative and determined that it was appropriate to schedule physician follow up which is exactly what occurred prince was then seen by dr mallett she looked at the x rays and decided to go ahead and refer and in view of continuing complaints not the x ray result down to standing in central jail where he could be seen in orthopedics by dr bertie who the records show is actually a u c s d physician as are all the physicians on contract for new county jails and that indication is it s c r thirty two and it was dr bertie of u c s d down at the central jail who performed another evaluation of prince and determined that additional x rays were warranted those are the x rays that were eventually interpreted differently and showed the dislocated and just placed bomb so what we're really i think looking at when you view this entire process in contact in context is something progresses and ultimately then the primary care physician refers the patient out to the appropriate specialists in this case a case orthopedist and then the appropriate corrective action medical treatment undertaken and that's really what we have here so when we're looking at deputies dale's radius and dunlop and what they did that night challenge or didn't do it night count during phase one argument they have is that well if taken as true we simply there was no referral simply because he said well you had your opportunity i'm not in ours we're not going to vote for you if that is the reason for doing it  that's that's the best i think that they have at this point plus the compliance that he had some my my i've got a broken arm so and then then we're going to cause ation as well the only question is whether any material  also whether or not those people were sent to the hospital and who was doing that and it was a nurse i think bartolome or something similar to that who was actually in the dispensary making those evaluations and those determinations and his thank you very much i know you didn't get to say it's not about the talk with us about the sheriff's liability that your briefing i think has covered that so thank you  i know that h m o's have a bad reputation but i think that if any one of us went to our office ition and said we had a broken hand they wouldn't wait nine days to give us an x ray and your honor is correct that we have more than just mr in this case that he told the deputies that sam was broken they it's in their own words that where they acknowledge you had your chance to go to the hospital they don't say i don't think you had an injury i don't think your injury  serious they recognize it's a serious injury to say you missed your chance to go to the hospital i'm not sure they recognize it was a serious injury and that and then i'd also point your honor to his cellmates affidavit where he said he