undisputed your honor that that goes into the issue of personal involvement in the question of whether the doctor had any responsibility even knowledge that the prescription had not been filled for that time period  somebody did well that's true but of course courts deal with questions of the parties to the gates and the parties who were sued we pointed out both below and here that there was no evidence and that there is no evidence in the record that dr steward or nurse lumpkin were involved in the process of prescription fulfillment course we know just by our own dealings with medicine that doctors are generally involved in the process of push it out but when you're in a hospital that nurse looks at that chart every four five hours and the nurse says all there's the pill you tell you take in these pills every four five hours not thirteen days this is a nurse certainly that there was some sort of mix up on fulfilling the prescription that took about two weeks you know what the gordon said casey says and deployments case a black letter intentionally and providing medical treatment he is deliberate indifference if a reasonable person would know that the inmate requires medical attention well intentional delay first of all and i think would be intentional delayed by one of the parties not by some third party who had that responsibility there's no evidence of intent here medicine and i don't think that evidence appears in the record about allegations i don't think there's an allegation in the complaint to that effect i think the evidence of the record shows that that the guards actually passed out the medication and don't think so unless that there's certainly not to my knowledge anything in the record to that effect and only that would happen unless there was some exception where the guard or the inmate complained or or made a remark about it in one of them that they would be supervised that process but i don't think there's any other evidence in the record the i would come back to the gordon versus frank case which was cited by the district court in support of this notion that here what happened here is that there was an assessment that that assessment ultimately revealed that this inmate suffered from a particular version of high blood pressure and he was there after prescribing medicaid the fault  found with this assessment protocol by apparently by the district warden and certainly by the apple e is that this process took too long or that the emergent level decided upon by  disagreement with the the physician's assessment protocol don't we have two different experts who's would disagree on that question well the apple is actually not named any expert witnesses both of these doctors have testified treated the plaintiff at other points during his life the first treated him in two thousand and six i believe at which point he was suffering from  unmedicated have blood pressure high readings and the other diagnosed him about ten months after his release from jail and they both do make conclusions that we have medications sooner that i i can't recall the either of them actually said that the emergent level in his protocol i don't think it one of them actually said this that the emergent level is protocol should have been at a lower figure one sixty o one ten for instance or something like that neither of them actually testify that with a they testify that it should have been sooner the problem with that is that's a malpractise argument that's an argument that we disagree with the protocol in place  this this protocol couldn't be an argument though that deliberate indifference is willfully ignored the standard of care that is expected well and to follow up on that i think we have cases that  qualified immunity deals with questions of clearly established law and that's that's what we're serving here that there's no clearly established law is ever held that a board certified physician can establish and follow his own assessment protocol that indisputably occurred here he established this protocol the other experts disagree with and in that's fine just this court has has also held that disagreement with the doctors assessment or treatment in the gordon case the nurse completed her assessment she completed her assessment decided that the inmate needed medication and but didn't give him the medication even though it was heart medication that was needed immediately and he died that night that's fundamentally different from this case where the doctor had an assessment protocol in place and upon completion of the protocol he saw the inmate patient it was it was the guards were sued in that case which also makes it different from from this case the guards weren't so here it was was the nurse in dr who says even guards would understand when someone's having a heart attack and die dies in a few hours well certainly in and of course those aren't facts here the facts aren't that this person suffered from any the only evidence of emergency here are high blood pressure readings he wasn't diagnosed with this eye problem until ten months his release from the jail almost a year from the time that the blood pressure he himself complained of a vision problems while in jail he did but those the doctor reviewed those and examined him physically and found that that the district court properly found that summary judge was not appropriate on this issue qualified immunity secondly it is inappropriate we believe for this court to get into the issue of whether or not there was deliberate a difference in this case because we think that in a fit in a sense they would be bootstrapping jurisdiction at this level when they shouldn't and then thirdly even if the court were to get into that there would there was delivered a different light again first of all with the whole issue of whether or not in fact there was a in this case the denial of medical treatment which would have and said that you know you got to look at the facts in the light most favorable to the apple lead and then determine whether or not there was a deprivation of a constitutional right mr proctor did and i may be wrong about this but it's my understanding that part of your claim is that the failure to screen him when he came in was deliberately and different judge you're not incorrect that's correct there are three bases that we argue were deliberate in different first of all there was a complete failure to screen when he initially came in and he is here is there any allegation or evidence that either of these defendants were responsible for screening your honor with respect to that we believe that there was in the sense that these they were involved in the treatment  protocol that was established by the facility it's are in this that we have we are we are in a strange place in this case they we are there are some discovery issues that we haven't completed yet they did file their motion and we are here and so that there are some things that we did that i think we're sort of stuck with the record we are still here record right and there has to be some after them to be deliberately indifferent right two things come to my one they have to be involved and two they have to know of some serious medical condition at the time first with respect to screening right in here's a problem that we have judge we if for them to even gets the point that they would even be able to provide medical treatment it's our contention that they would need that as a initial war as to what it is that they're dealing with some of the other doctors the two of the doctors that testified in this case we we ask them questions about why you take history what the relevance of a history is so they got into all those things the council what day was he admitted to the jail twenty fifth of september of two thousand by october five they're starting a chart of blood pressure you know so by october five eight they really were on blood pressure readings and my clerk says within about a week after he got there he had a full physical assessment i think by the nurse is that term how many days after i should ask the question how many days after he got there was it till he got a value in there now we think it's about two weeks before he actually had a a medical screening he did see the that he wrote they've started to chart of these blood pressure up and down sideways and readings and all that well the problem is when he came into the facility his were continuing that his blood pressure was high even from a stamp a from when they first began they should have been monitoring it all  which they if they had done it properly as not just monitor they should have been given his blood pressure medicine and that's the job they would do is just assessing it in an assessment is not treatment and that's the problem just because they knew that he needed blood pressure medicine they did nothing to help them to facilitate getting the blood pressure medicine and actually they wrote a prescription but your honor that was over thirty four days after goes into november five right over thirty four days after he had been complaining why didn't he get the days or thereabouts well here's the thing that they say they didn't this is how we believe they did it they say that they were monitoring the blood pressure logs on a weekly basis if they in fact were doing that they would have determined that he did not get what he had not gotten his blood pressure medicine and they were a black eye white his blood pressure is going down you know during this period of time it's on a downward tilt right you know throughout november isn't that odd you know during this time they don't get in the pills pressure goes down a little bit well and it may just be coincidental so if they were monitoring it they may well have thought that he was getting well the problem is they were much it was still at a merge and level i mean his new blood the blood pressure we all had now their doctor says one hundred eighty and it's it's a one for sixty going down from a fifth of november through the eighteenth but it's basically down during that period respect the judgment that was stroke level that's what our doctor the two doctors that we had basically said yeah but now you're back to medical malpractise i have my special very simple on the prescription just to follow the pharmacy is discuss the legislature didn't get money what do you say what do you prove was the reason he went fourteen days without blood pressure pills it was the doctor's fault and the nurses fault and the facilities fault it was all  what did they do now often often you know i gave you my terrible example i'm only going to hospital the doctor writes that prescription and then do anything else out of ever again in my experience right then the next year and six months six months you talk to documentaries or year later well that it was emergent so she had an obligation to make sure that he got the feel and the guards have the mayor i know it's unpublished it's case call we was versus arnold and it's an eleventh circuit case about getting prescriptions for a person in alabama jail and the conclusion is at best aleisha suggest that the jails methods of procuring medicine the local pharmacy needed adjusting even so this would have been negligence not deliberate indifference you know about that case that's a whole another case you're i don't know it's being monitored well and we have a and i guess that's what we will we have a kind of an issue that the district court i believe gave credence to factually that the blood pressure was the is the the level that they were at or that one eighty was just a monitoring tool and not a actual of reading that you should be looking at in terms of whether or not it's a virgin or not so i think that's one of the factual things that we haven't any issue with because i think the district court sided with the the two doctors and found that you have that i mean one eighty is way out of the question i mean with where he was he was a struggle so the problem was is that when those doctors if it even was though it going down it was still at a level where they should've been given the medication and so it's that there was the day in which i mean the nurse i mean nurses and the doctor should have if they were reviewing the charts both nurse both the nurse and now that we know the doctor says he did it every week he went to church how often does a nurse say she reviewed the charge you're the other side down there too many him the blood pressure so we can assume that when she signed the chart that she did that but i don't have an actual number that she actually did i know that there are sometimes she actually took she actually took his blood pressure and i got most of times it was done by the guard it was most attached but there was a time that she did as well so it was in those times we would argue  that that was there but the we have two other problems even even if we the the problem with the delay is an issue but but just the ride out the mile is something that they have a problem they can't get around i mean the they did not know for thirty four days they failed to give this man blood pressure medicine which dr choco who was a he is one of you am at university of arkansas medical science one of the leading is situations in the state of arkansas and found that this lead to was partially responsible for his blindness so the failure to get medical treatment actually cause mr forte of heart to become part was part of the reason that he became blind so there was a there was a consequence for the delay in the medical treatment for those three four days that that the district they try to do is to get this court to go a little bit further and say that there were issues that were intertwined then and there they want to get into this whole issue about whether or not the the district court was proper in denying the summary judgment on the other issues but you know we just don't think that's appropriate because this court if you find that there was that that that the qualified immunity was satisfied and i don't think we're going further and then there's that the third thing we said that there are three parts of it which was the we have the denial and then the delay in treatment so we would argue that those three things with would indicate that that summary judgment was appropriate the other parts of our argument deal with whether or not the denial of the summary judgment was the failure to actually give the prescription sure what is it what allegation is there and what facts are there that put the this nurse and this doctor involved in that process ok or good question in here's how  can find anything in your pleading that said they were responsible for doling it out or you know failed to do so that's why what and i think that the actual doling out may be a little bit murky but the   this give them october the fifth at the best they knew on october the fifth that he was he said my blood pressure is high i need my medicine call my sister and and the nurse said ok you know we will in effect call we testimony the record that that the family was never call so that's one thing also the the fact that on a if he was in fact monitoring the blood pressure as he was a player as he allegedly was doing there were periods of time where the blood pressure was clearly at a level that dr choco said led to him being blonde miso that's the best something there and that's the thirty four day period right talk about i think it's twelve days the twelve the thirteen day ok well during that period of time again i think the  see how they were involved in the thirty four duckery i don't see how they were all twelve and it's ok the it appears argument there one that they were saying if he were really looking at the medicine log like you're supposed to you would have actually found that he was not getting his medicine because his although that the blood pressure readings were going down is our argument and i'm no judgment here that that you point that out but the problem is is that it was still too high and that's our once you get around to giving the prescription for the medicine given where he was he should have made sure that he got it in that thirty four day period was just too long and i think our doctors argue that at least that that's part of what it is that the yard about th made an interesting statement which is that assessment is is not treatment but i think certainly assessment is a component of medical care and that's what's at issue here both of the other doctors even that disagreed with our doctor agreed to some assessment is necessary to determine the need in type when those huge of blood pressure medication they simply say that they wouldn't have taken as many blood pressure readings as our doctor that they in their normal practice they stop much shorter than that that is ultimately a malpractise argument that is an argument that in this locality this is the way doctors do things and he did it differently the implicit argument that his emergent level was too high is the same argument it's an argument that a local doctor disagrees with with the way he he did this that argument doesn't suffice with respect to whether this court and get into deliberate indifference and question deliberate indifference it certainly can qualify i mean one of the components of i mean the is whether a constitutional right was violated and that to the doctor we would submit the same with respect to the nurse there's no cases stands for the proposition of a nurse can't follow an assessment protocol established by her supervising physician in this case dr stuart and that's the evidence in this case with respect to nurse lumpkin that she simply follow the protocol instituted the blood pressure low and when it reached the merge macalso it's not following a protocol when the patient is not getting the medication so that's one thing nurses normally check  had any control responsibility for how many the blood pressure readings to the nurse take what is a record i think it was three or four if i recall correctly were they in the period between november five and november eighteen fifty over two hundred well certainly i think that's think the crux of what the court deals with in this case is that at some point this could become deliberate indifference going i think it it could i don't think you can say merely because there's a disagreement of kids in medical malpractise i agree that there's there's some latitude in there certainly if a doctor said i'm going to monitor the blood pressure for two years on some level but that also assumes that a board certified physician is going to do something that outrageous in this case it was a thirty day protocol not a three year protocol it was a one eighty over one twenty not to fifty over two hundred this doctor but other doctors are saying one hundred one twenty is too high certainly but they don't give there it well actually that they did they didn't say that they said they would have just administered medications but didn't one judge allude to one sixty i'm relying on your stuff so tell me if i'm wrong i don't recall here of the doctors testifying about it should have been a lower number my recall is