this is from the appalachian have explained mr lee was not transferred to a hospital which was capable of writing or with life saving medical care based on a policy of practice inside the jail which prevented him from doing so this ensured her death what was the policy that that's correct so how does that show a bit they didn't provide proper medical care when they are required to get a doctor's approval to transfer a patient in the hospital now that dr wells may have policies practice customs or protocols we know that he didn't report to anybody concerning and we know they didn't have to ports anybody about his decisions to treat or not treat innings therefore the authority concerning medical decisions was given by the county directly to the doctor and that was the county's decision to do as per the contract she signed with the doctors sheriff was not a party to that contract it was that it was between the county judge and dr wells thereby showing it to cut at the county intended to make dr wells the final decision maker without any review whatsoever with respect to medical care at the jail this is further evidence drawn by the by the disclosures in this case which show you struck what the policy was what exactly a facto policy your order is different from the written policy as this article court has found on several occasions so in this case that a facto policy as evidenced by their scrubbers in there smith was to refrain from transferring inmates to the jail approval actually there's nothing wrong with that policy facially there's nothing wrong with that policy that is correct on the presumably they need to have somebody who has the ability to make that determination make that  through some electronic basis he was looking at the e k g s or whatever it was he received a copy e k g sometime after it was taken via cell phone photograph those records so it was sent to him and he looked at and again i don't know what's in the record in this respect but he looked at it and he said you know i'm not transfer to the hospital he actually didn't say that you know or he said let me know what happens next all right well the record clause it doesn't slowly despite the u s law is the clinic you hard a competent physician to assess whether in might should be transferred to the hospital was the county on notice that that's a that's a nickel to her ma what is the policy of limitation the policy of limitation only if you just use the term policy of limitation maybe i didn't hear you correctly not intentionally you know i referred to the conditions of  not at all your honor and i believe that that issue is adequately briefed i believe that the individuals here weren't back deliberately indifference as evidenced by the fact that both nurse roberts believe the shoes having a cardiac event by the fact that judge the dr wellesley's she's having a cardiac event the both did not know then that we know that they did not a reason e k g we know they didn't know the cagey passes self diagnostic we know they didn't know to transfer to the hospital and we know they didn't know whether or not they had the authority to transfer to the hospice or court address a claim of failure to train help me march of that year when within the space of two years was that it was like six months and one year and fifteen months and i know you and your brief you talk about how this case was transferred to another lawyer in the lori was incapable so i came that still doesn't help me how many months between the death and that end of the two years which they did not find he did not ever know the body could often be providing medical care in this case the county disclosures never identify the surface the policymakers are always seven hundred and thirty five they are going to find some with knowledge of the policies of the jail not even medical policies of the jail and in this case we also know that wells was fully responsible for everything that happened at the jail had full reign in control of the conditions of confinement we know that there was a policy procedure that prevented the access to the hospital we know that dr wells delegated authority but in this case and in other and what we know is that the actual policy of mclennan county was to provide constitutionally adequate care to its prisoners that's what they'll services plan said and that's what the contract with the doctor  provided for but it another way to look at this case is not only from the policy down but from the facts up to see that cannot be a liability against the county or actually any of the individuals because of the care that was given and if you look at the time period it's ten hours that miss lilly was in our custody from eleven thirty am when the district court said you didn't pass the drug test you need to go to jail lemon there was no policy that prevented anyone from accessing the hospital that was proof in this case as to what was actually going on but if you look at that ten hour time frame you can break it up kind of conveniently three sectors the st six hours the next two and a half hours and then finally the last hour and a half roughly for six hours lemmon thirty to about five hundred and twenty dollars that period of time was when miss lilly was taken into crying but not complaining of anything she was crying upset that she'd been placed in jail but she wasn't expressing any pain or any any symptoms at that time and i don't want you to forget that because this is a helpful chronology but  what if any data is shown in the jail records etc the fact that i believe he with pays three times at the court yes that came out in this chronology it came out in the  it was part of her when the when the criminal district court said you're going to go to jail now she got said and she was tasered at that point but she's telling now the nurse i was tasered and of course that may account for the neck i was on the back presence any discomfort in a chest she says she has some arm pain which she attributes to the fact that the jailers have lifted her up but she also says chest pains and so says consider acute stanley s t elevation and consider acute informed those are the readings that are on the machine so six indication that something here could be wrong so that nurse then gave that information to the director of nursing with l d n nurses and we have the director of nursing who's an r n that's nurse roberts and so she looks at that agitated so the nurse roberts thinks i don't think this is an accurate reading of what you did and she instructs of want you to at the next shift so it's six hundred and thirty now the next shift begins at seven she says ok the next shift i want you to go and take another reading interview now nurse ryan fleck she comes in at six hundred and forty five early for her seven o'clock shift she says ok she's going to do the pill pass give the pills to all the inmates and then she checks it and she checks it twice each and she doesn't she not try to read it but she does check it twice and she gives it over to she reports it to nurse roberts as to what is going on here and the readings readings are consistent so th it she communicates that to to nurse ryan flies now then we get to eight o'clock that's when we're so we had these st three e and on the rd the last e k g there is instructions given nurse robert says ok what i want you to do is i want you to give her an aspen three hundred and twenty five grams of aspirin i want you give a nitroglycerin and owner calm down and take her blood pressure after that so that's what she does and she also says and i want you to give the information to lieutenant ward which she does nurse right place does all of that then she checks significantly she checks the blood pressure after the aspirin in the nitroglycerin and it's normal so at that point she stabilizes about eight o'clock so now we're entering the st so the phase between fi that point then we start the last hour and a half during that last hour and a half there's communications going on between nurse roberts who is off duty and off premises but in communication contact also the doctor who's off duty but is in communication so there's communications between right sliced and roberts and wells the doctor the director of nursing and the nurse who's on the scene and they have communications about what's going on dr well ok i want you to check on her i want to communicate to the nurses that i want you to check on her she could possibly be having a heart attack but i so i want you to check on her and they said ok we'll do that in the meantime but interrupts that is a jailer saying she's non responsive we rush to go get her and we start treating her immediately nine hundred and eleven is called paramedics arrive and they try to resuscitate her but all the while along the way everyone is trying to take care of them so miss lilly you can question their judgment you can you can say you couldn't show but what you can't question is the fact that these individuals were all trying to do the best they could in a in a difficult situation and they were responding they weren't doing the classic test for deliberate indifference is simply not met under these facts and the district court did a fairly thorough job of analyzing those facts and saying yes these people were not deliberately indifferent and all you've got on the other side is some allegation that these amendment the standard would be deliberate indifference on the case law here versus core the city current case that this court has to stop deciding so there was more than just a minimum of effort to take lilly her tragic demise was not caused by any policy of the county nor was it caused by deliberate indifference by any of the individuals present they were communicating about her they were constantly there was a constant flow of communication could have been better of course but that's not the standard they were making effort all throughout two to ass and address what was happening and i notice that my time is is is just about out so i would just say with regard to the the county there there is no policy other than the policy to provide the constitutionally required level of care and what you see here is an effort to do that this is not a situation where there is a this is this is an episodic x or mission case it's not a conditions of confinement case and as as an episodic act or a mission case it is one that we look at and we say was anyone deliberately indifferent because if anyone was deliberately and different than that's a constitutional violation there is no one here who was deliberately indifferent secondly and only secondly would you go to the next step would you be ok if you were to find that some individual exhibited deliberate indifference then you would have to say was that deliberate indifference caused was was that caused by a policy custom a practice of mclennan county absolutely not the county you rest of my time to my colleagues actions which began at six thirty pm as establishing the record this was a this is until a summary judgment and so on the left side of my chart you see statements taken from my client's summary judgment motion and then you can on the right side say that they sync up with those she believe that if there was a doctor there and available that the doctor needed to make that call and she said that to the texas rangers and she did express a summary judgment at that if the doctor were available she was not posed in the case follow up one of the issues are neither one of them were at the jail this is after their shift they are working from home you know it's clear that nurse roberts didn't just abandon ms lily's treatment after she left work for the day she stayed on the phone she gave instructions to the nurses she told him you know please administer aspirin please mr nitroglycerine move this inmate to the medical wing check on her within did not receive any formal training of the record doesn't reflect that she had formal training in reading e  short i think if the court orders to review this continue month that i've laid out in this chart you'll see that district lines urge for the st time appeal on and and i'd add to that just barksdale because equitable stoppel is applied in texas is very limited basically to cases of misnomer actions including any kind of extensions of the extensive limitations including equitable stoppel right and so that's why it's important in my brief sidespin texas and federal cases because both are relevant to this but they're also you know very consistent to their consistent with respect to when the statute of limitation accrues which is when the injury occurs a person should have known of the injury and it's consistent with respect to that th statute to limitations is not extended because a party does not know the identity of potential parties to the case the state's a limitation actually affords the opportunity for a party to discover that kind of information in order to be able to sue on tom the you know why is that going to be was not revealed and repeated discovery i do not know but all i do know is not which ultimately the information was obtained but in any case i believe that that's the real issue is there's a two year period i mean counsel did explain some reason for some delay during that two year period but nevertheless the stage limitation imposes an obligation on a party to use that period of time into the get the information they need to be able to file their lawsuit the the one thing i want to address is a case that seems to be the basis on which plaintiff the law is and that's the united states versus cooper it case that case is i think i think frankly favors my argument in this case and does not suggest that the statute of limitations should be extended because the defendant is not just has not been able to defend if it's not been recovered it has nothing to do with that and in fact the an obligation to investigate their case and given the period a statue limitations to do that including a den upon potential parties to the case of leave as much time thank you calling for the record for the propositions staffing conditions of the jail are found as honorable court to be unconstitutional condition of confinement that was also an incorrect citation that site was intended to be scott the more eighty five dollars f three d to thirty nurse roberts provided mr lee with adequate medical care despite the fact that even nurse even dr wells finds her conduct as unreasonable if a criminal defendant would exhibit signs of a heart attack in this