this is a matter that involves the administration  a treatment regime where we believe it will show by the gravesend and also today is that while we've raised a number of issues i'd like to focus on three areas one of those areas is the lack of consent and medical battery area where the judge directed a verdict at the end of the plaintiff's case the next area well as the judge the trial judge directing a verdict verdict release who was the primarily responsible physician essentially on the basis that although she was a licensed physician she was a resident indeed as he put it the low person on the totem pole the third point sort of an overall point is that the kamala to the fact of the trial court's rulings in this matter deprive the plaintiff of a fair trial we believe that on any one of these points and there are some some points on the fair trial part that if you need these points had gone differently the matter very well may have resulted in a verdict for the plaintiff and taken as a whole it shows the plaintiff did not have a fair trial we're not here today to make a new law we believe the law is very clear on blackett consent medical battery but we're asking for is to have a trial in conformance with that long and we're all so asking to have a fair trial by a jury that's allowed to weigh all the relevant evidence the standard we would buy in the plaintiff and trying their case on the medical battery is based on the cases we've cited and make versus university of it's simple it's straightforward consent to the administration of the eleven x regime second question did he refuse that trade night and was that documented yet not honored by the doctors we believe that the judge is taking a battery case away from the jury was not supported by any of the evidence and in fact there was sufficient evidence that zydeco did not consent to the shots and furthermore he refused  one of the points is that on directing the verdict there was more than slight albums for denial of that directed verdict for them or consent issues or for the jury not for a j the scope of the plaintiff's consent is crucial to his ultimate recovery in a bad reaction to time place and circumstances where fact the nature of the consent given these questions however of questions of fact which are to be of thirty six is the guest of an action for a medical battery is not the hostile intent of the defendant but rather the absence of consent the contact on part of the plaintiff gaskin the court and gaskin made it very clear that under illinois law claims alleging a cold a lack of consent to medical procedures are treated as batteries because they involve an intentional on the rise unauthorized touching of the person of another recovery under a battery theory is allowed to read the treatment as either situation is doctors ordered that nurses give their medication to patients that was determined to be a battery if this case we have doctors ordering a nurse to give an injection to a patient there's no question there was no consent no written consent in a file all consents and in the record of all places documented in the record on this on one page it specifically the nurse says when they go in to give them the first woman that shot patient says i don't need blood thinners if she puts in their patient has refused treatment dr maurice was dismissed alo notified they had this documented in the chart you know about an inch point on dr maurice is that i really believe that once she was the primary responsible physician this is a doctor who entered almost six hundred orders for this patient over an eight day period who saw him when he initially came in she ordered the ministration of the eleven x she was told he didn't want it to did refuse she didn't enter in order to discontinue it she came back out in after some time off and agreed with the other physicians to continue it she's a licensed physician the food points and there are a number of points on this basically what happened is the plaintiff was constricted in what they could prove we were limited to a seventy two hour period when he had been when he came into the hospital his dad they get a cat scan they don't read it for seventy two hours they get it they decreased the dose but by then he's already had massive bleeding on the brain we were not allowed the defendants were allowed to go back tonight to name united say how sick this man was look at all this prior care we were not allowed to put in our case or cross examine the same doctors they called us experts were involved in the prior hospitalization in sikhism this how you get it three weeks before nor are we allowed to show that they decrease the dose and then stop it based on a cat scan the chips a row you haven't said there's anything those were deviations from the standard a careless if you're exactly right those are the standard of care it seems physicians same hospital we were affect your kidney function and get this hassle ization could you tell us that this was this hospitalization they did not monitor properly did it i don't think of procedure they were supposed to if there were certain kidney below the thirty number where they said you should be given a moment ups one of their experts admitted that on cross that when he did the math that came out of his notes produced at the trial it came out to thirty which minute should have been stopped it was not clearance based not on actual body weight but ideal body weight i objected under to thirteen the judge allowed it in and they had a free expert saying this is how you calculate the crip and clearance i objected under to thirteen i did a motion to strike i did a motion for a mistrial i did a motion to be able to call rebuttal to bring in the fall just in to say this is not the correct way to do it so there was one of the significant points in this where they allowed the second girl resident who was not  and correct we were not allowed to bring out in another expert to rebut that the first time anybody heard that was in the court room it was objected to under two thirt scan that showed his brain was free from the c l o from any leukemia any infiltrates we were not allowed to sure that women in who walks into the hospital on june twentieth is given live an x at not just a prophylactic dose but a treatment regime very aggressive regime and thirty's later he's got four brains bleeds on the brain that shut his brain down to the base of the skull the only thing different this treatment this hospitalization from the other ones was they put him on this treatment those were not allowed to go into that prior cat scan to sure and this is why the same hospital the same doctors the same people saying oh we looked at the spraying there's nothing wrong with this brain because of leukemia experts in that they used some of the doctors in the prior hospitalizations are experts i should be able to cross examine them he said isn't that correct that this is the proper procedure if you suspect pete you put him on a prophylactic goes you get a cat scan if there's nothing there you stop it i was not allowed to go into that and they raised the point they said well you can preserve that or whatever then for the prior record was not just an offer approved it was put in it in the evidence i have  the defense is calling treatment ok it relates to everything in the fed the thing is the defense up to the point of the trial and even during the trial acknowledges that a little bit this eleven x regime is a treatment if you look at that consent form the consent form applies to everything there's no exception in there for medication and in fact if you look at it sort of divided into a hierarchy where the less important items were the more serious were the most serious ones when they list the items that aren't that important they talk about physical exams drawing blood taking x rays they don't put in their medications you don't need a consent form even for those things even if you do a physical or someone a drug or blood you still have to get an oral consent and documented  the chart we have for a medication that their doctors have a knowledge has a significant risk of break bringing believes and yet there's nothing in the chart and they took the position and one of the things i objected to they had never to live next twice i understand it one time the what happened is they came and given the first shot it's not clear from the record but within an hour of when they said begin the first shot the nurses recorded his refusal of the treatment in fact they don't give a term that afternoon but what happens is dr maurice close for a day or two off she admits she does not do the transition to the next doctor to say by the way this guy is refused that which they normally have a form they do this transition it's clearly in the rocker the doctor that did not know it that came in and started him out of again but now opted to from thirty twice a day to seventy twice a day said everything was there but i didn't know it refused it and he was alert that time according to the terms oh absolutely in fact the doctor i put some are the doctors on his adverse witnesses the doctor that up at about six o'clock in the morning said yes i was talking to him he was alert he was oriented and i said well did you discuss the overnights with him no i did not so it's not like the man had a significant medical problem or was asleep or somebody couldn't answer for him we have a very intelligent man here this guy is a civil engineer he's a surveyor he'd been through this three weeks before it he said i don't want it i don't need this is there anything in the rush protocol that says that once somebody refuses something they have to use it every single time you know what happens in fact it's just the opposite once they refuse it the protocol is pretty clear that once there's a refusal you have to start from ground zero again with all the consent never a thing else of that nature is that i don't need i clearly understood the the effect of what this if we don't they can't write down everything now but it's clear on that and i attach it as part of one of the supplemental record that particular page if you look at it the  cold patient says i don't need blood thinners the reason he said he didn't need him was you know but she obviously understood here's the thing they said this is medication it's not a treatment for their own nurse writes in the record patient has refused treatment she doesn't wear a patient is refused medication or shot they clearly understand that that is a treat right and there is nothing in the record that anybody except you did on his behalf that's correct no exceptions there's not even an oral consent in there where the doctor says i discussed this with the patient he consented absolutely nothing absolutely appropriate the plaintiff failed to establish a prima facia case for medical battery specifically there was absolutely no evidence presented by the plan to show that and those doses that mr spec because the lovenox that it was given when he was admitted he was appropriately even according to their expert place on the prophylactic dose of lovenox this is to prevent a p it's not because they suspected he had one it is to prevent one given his underlying medical condition his age and the fact that he was bedridden he had an oxygen saturation of eighty percent is extremely lol his oxygen needs were increasing dramatically he had respiratory issues going on in the underlying island sea out al which is the more i can see of the blood these were all indications that he should be on a prophylactic dose and nobody criticizes that he gets to thirty milligram dose first dose in the morning he tells the nurse i don't need blood thinners and the blood thinners are not given in the afternoon at four thirty the following morning he has an acute respiratory situation where his oxygen saturation strop his blood pressure bottoms out and doctor when the other first year in turn whose job is to transcribe order is given to her by the senior people there she is not making any independent decisions nor was dr maurice making any independent decisions dr went increased the dose to what is called a therapeutic dose at seventy milligrams twice a day as mr mcclelland pointed out the patient was alert in oriented he knew how to refuse medications he had done it before and had not been given to him at the time he obviously accepted bestows it was given to him when he was in this situation on the morning of the twenty third the twenty second it was the afternoon dose or even dose i should say on the evening of the twenty second was given and the morning of the twenty third it was given he then refused it again and it was no longer given the situation that it put him in extremis on the twenty fourth occurred more than twenty four hours after the last dose of broken ice was given and there's absolutely  no all the witnesses agreed that the lone nuts would have been cleared out of his system by that time there plaintiff has failed to prove that mr secrest ever got any treatment that he refused at the time it was being given it is obvious that he knew how to refuse it and when he did it was documented on the medical record that he had refused it the consent form that mr mccloy and i talked about is not applicable to medications it would be terribly unwieldy if you think about the i think this man must have been something like thirty medications if you needed a written consent to give somebody an aspirin in the hospital is just not the way it's done what does  what is done is if the patient refuses it is documented that they refused and in this case he did that they did jackman he refused and it was not given when that dose was refused to go back and jackson meant an acceptance when it's obvious that he accepted it by taking the medication that was offered the plaintiff's expert agreed that he did not get the low binocs on those occasions when he was when he had refused it there is no testimony and i think it's just the apps that every one of the doctors agreed that the test that the consent policy is not a pleasurable to medications despite the fact that every medication from an aspirin to lonely nights is considered treatment it's obviously a treatment but  is not an invasive treatment it is not an invasive procedure now the policy doesn't make that distinction but if you look but in the medical records it is clear that all of the written consents that are in there were for invasive procedures such as a broadcast a p the insertion of certain lines that type of thing it is not there is absolutely no written consent in there for any of the numerous medications he was on because it's not a clickable mr mcmillan argues that he should  that the doctors should not have been allowed to testify that the that the policy was not a political but he never made that objection at trial he never made the objection when he amended his complaint on the eve of trial asking to add the medical battery count based on the power see judge three i know said you can amend your complaint and add that count but i'm going to let them talk about this policy and explain what it's about he didn't object at the time he didn't object dr maurice or any of the other doctors testified that that policy was in a political to medications and he had no evidence contrary to that the policy alone is not sufficient to raise a question of fact here to present to the jury they need to assess he needed to establish that the policy was the standard of care were there at the policy itself applied to this situation and that by and that the policy was violated and that the policy cost of the violation policy caused the injury this policy deals with documentation it doesn't deal with the actual procedure it deals with documentation so it does not have any effect on the even if the testimony by the physicians were getting in the public ability of the policy was excluded the plaintiff cannot rely on the documentation of consent to show whether or not because he doesn't have any testimony to say that the plaintiff did not the decision did not consent at the times that the medication was given and that's his burden mr secretary is presented to the hospital for treatment this is significantly different than the mink case in many cases these women were used as guinea pigs in an experimental procedure they were totally unaware of pregnant women who were given d e s which is a drug that currently is used to prevent miscarriage that caused birth defects these women didn't even know they were on this strong or that they were a member of this experimental group they did they there was a total lack of consent here and in that case in this case mr secretary presented to the hospital for treatment he did not walk into the hospital a healthy man he walked into the hospital with a deteriorating condition cancer and yes a psychosis in addition to pneumonia and decreased respiratory status he gave consent implied at least to all the medications he was taking simply by taking them as mr mcmillan said he's an intelligent man he could easily get refused and at the times he did refuse it was not given and there's been no testimony that it was given and moments when he refused the policy regarding the documentation of consensus was in a political to medications and there is no indication that mr secrest ever received any treatment that he had refused the directed verdict on behalf of dr morris is absolutely appropriate dr marty there only expert testified that dr morris by transcribing or writing the order for the thirty milligrams of lovenox hunted mission was appropriate the twenty second she acquiesced in or as of the twenty or twenty three so when she returned to work on the morning of the twenty third that her acquiescence in the order entered by dr went twenty four hours before somehow is should have kept her in this case but there's no there was no showing that she was aware of the order they were with the rolodex was only given one more time she came in about six in the morning alone x was given for the last time at nine  at morning there's no testimony that that if even if she had disagreed with that order as a first year in turn if she had brought that disagreement to the notice of dr schleifstein or dr so long that anything would have been done differently the attending and the senior residents both agreed that this medication was appropriate to seventy milligram dose and i think the proof is in the pudding also in the fact that doctors still but the jury found in favor of  sliding and dr went and the only doctor when did was write that order for the seventy milligrams so there's no reason to believe that they would have found against dr morris for that and dr murray frankly did not criticize that order in fact he specifically said he did not have any credit he thought it was appropriate for them to increase the dose of overnights when his respiratory status changed to four o'clock in the morning on the twenty second because there is a concern that it might have been a p e turned out it wasn't but that doesn't mean you don't treat it if you believe that there's a possibility it could be the jury had no basis to find that dr morris i deviated from the standard of care or that anything that she did cause to contribute to her  that matter he argues that he should have been allowed to present evidence that the administration of lovenox during a prior hospitalization should have been allowed in order to establish what the truth standard of care is with mr ration of love x but he never made an offer of proof as to what that testimony would be or what anybody would say with regards to what the administration of lovenox would be in a situation such as the one mr secretary presented with during this admission his condition was very different than it had been a couple of weeks before but the bottom line is there was no offer of proof that they had anything about the robotics and his tracing during the prior admission would have had any relevance at all to the and administration of overt acts during this admission and furthermore anything that a doctor doesn't apply or occasion doctor's personal practice is not relevant to establish the standard of care and that's all he was trying to do with this stay see this is what they did the last time he was in that's the standard of care this isn't the standard of care but we don't even know what that contact was because he never made an offer of proof about it he also argues that the testimony that the c t scan done on june twenty first when he was eighty percent and they wanted to see what was going on in his lungs as it turned out he had pneumonia and a lot to says he had a c l o his lungs he did not have a p e it did not it's not no we said that it took seventy two hours for them to read that that's not true and when he did compensated ten hours later basically that c t scan is irrelevant in showing whether or not he had a e or whether it was reasonable to believe that his d compensation was caused by a p e ten hours later and i think that in the transcript mr ross actually used a great example he said if you take a picture of an automobile now pristine condition and ten hours later it's been sideswiped by a man trough it's going to look very different this picture is irrelevant to show what is going on ten hours later saying here in this case the  doctors testified that the they could not rely on a c t scan done on the twenty first to show that there was no p e on the twenty second so it was appropriate to can be concerned that that's what was going on given his d compensation can we just talk about the consent issue from sure absolutely he's it your position they add an alert patient every single time a nurse or someone approaches with a bunch of medicine has to mean he can't change his mind later will do you have to document that he has changed his mind you know he is agreeing to it i don't think you have to decorate that he that he agreed to it i think a document that he did not and that's what this is what the practice was any documentation that he was asked oh sir i know you said you didn't want the over next before but i have it in my hand no do you want to this time no the next time that he took it after he gave that refusal well first of all this is not something that would be documented but after he gave that refusal on the twenty second and the twenty first he did not get it again he got the one dose and then he did he got it again at ten am seventy milligrams to thirty one grams on the twenty second and again at nine pm seventy corrected if you please show me i'm wrong and then he was in a coma so he couldn't refuse it or accepted them when his condition deteriorated dramatically at four thirty in the morning on the twenty second and that's when the dosage of lovenox was increased and that's the first oh the first dose he got was around ten in the morning but that is why it was increased in their acts because any criticism of that company my question is did somebody say you know what your could not recall the conversation she had with the patient that morning and it's not documented no it wouldn't be and it wouldn't be no so patient refused there's nothing that anybody could look to later that says a patient changed his mind ok now other than the fact that it was  apparent that he accepted it because of the fact that it he did not refuse it it is documented when it is refused it is not to be documented every single time if the nurse had to spend that time every day and he was on a list of medications like this going through saying have it in my hand how about it and give them another chance either accept it or honor his refusal in actuality he refused numerous medications numerous times throughout the hospitalization and treatments and treatments and those things were documented if he accepted the medication the next time it was offered it is not documented patient now except it is just documented that he took it he was on the refuse well i think that the the evidence the plaintiff has the burden of showing that at the time he was given the medication he had refused it and that is not dead so there's no evidence of that at times there doctor because there are to go to whether or not the treatment was rendered the trip whether the trip was rendered against his consent i think it's implied that the treatment was rendered there's no testimony anywhere or that the standard of care requires that the policy requires that documentation of the patient's acceptance of medication be documented were any of the pain any of the medications that he did receive pain medications i honestly don't know what any of the pain medication i have i have the church in front of me and i i don't recognize his name so i don't know you  o i do not judge without without it being present i'm reluctant to i have to rely on the briefs however hospital personnel were to document each time there was medication rendered or given to a particular patient well i think first of all i think the testimony was and it's unrefuted that the seat does not apply to consents for medication every doctor testified that the power seek it does not apply to medications that being said yes that it's not at the hospital that the policy would be taxed or that they think they would be put to more people what they do jack a much when the medication is getting let me read when i have purpose of consent hospital personnel have a legal duty to refrain from last treatment has been authorized by the patient similarly the patient has a right to refuse to authorize treatment a consent is obtained from a patient or treatment in order to protect the physician the nurse and the hospital against claims of authorized treatment any treatment or procedure which poses a risk to the patient should be authorized in writing after the risk and complications have been explained to the patient a consent given to a patient after such an explanation is commonly referred to as informed consent wire in what i've just read suggest that the decision in this instance subsequently withdrew or it as you apply what i've just read to the consequences leading up to  e the season's passing would suggest that he had any point revoked his denial of treatment he indicated quite clearly i don't there and i hear you arguing that he waived that by receiving treatment and going forward for the next three or four days that he remained in the informed consent and this was argued back and forth at the beginning of the trial that this was supposedly not an informed consent case this was supposed to be a medical barry case and as judge syriana pointed out this man a net maybe himself to the hospital for treatment that is accepted it's not like he wanted to walk away now with regard to the specifics of this when his condition changed and he his and quite dramatically the next morning and his respiratory blood pressure dropped it and then he accepted the role the next for the next three doses but only the next three doses i think it is fair to assume that he understood his condition and decided to go along with that treatment because he certainly knew how to refuse it if he didn't want it and he was he was a smart man and he did pick and choose the types of treatment he wanted to receive throughout his hospitalization so i think that there is an implication and certainly i think it's a quite a strong implication that on both occasions when he took the medications he was offered he was accepting them and on those occasions when he refused the medications he was offered he did not get them and that's where the unauthorized touching comes in it's not he could have refused all medications from that point forward he didn't he chose certain ones at certain times and and profusely met other times i don't think that that and there is no written consent  medications that policy is not applicable despite what the plans were plans attorney would have you believe all of the testimony from the doctors specifically said it doesn't apply to medications if the patient refuses it yes the nurse documents that they refused it and he needs to read knew his refusal before he received any further attention which in fact did they have to know and he refused it the first day he took the first dose staff on his original statement i don't need but that's true that's that is a i suppose that data could be interpreted that way i mean i think the bottom line here too is that the doctors were not there giving the medication they wrote the order for it this was this was a battery count against the physicians not against the nurses there's no allegations against the nurses here and yet so that if the doctor writes an order and the nurse and the  patient agrees to accept the first time and it's taken and then doesn't take it the second time but the newest is that anyway that's not on the doctor and that's what this plane of the plane it was arguing that this case was against the doctors so she waits the order for the for the nurse to get it and it shows wait in response to the acute situation that's going on at four thirty in the morning and dr marty agrees that that was appropriate because of his condition at that time so that water was appropriate now there is no evidence and if the plane is going to show that there is that there is evidence that he refused that dose because there's no there is evidence later that he refused doses and it was not given there's no evidence that he that ok with you as i said dr went could not recall the specifics of the conversation she had with him at four thirty in the morning i doubt she was there at ten o'clock in the morning what is being given doesn't the form see that this is the physicians responsible for fully informing the patient with consenting yes but that consent doesn't apply to medications it applies to invasive procedure is that there is no testimony from anybody that it applies to medications in fact all of the evidence all of the testimony is the complete opposite it does not apply is sloth and acts sites a medication also a treatment for a specific kind of circumstance all medications are as well so if somebody walks into the hospital and really all they need is  an aspirin and a painkiller they don't have to sign a consent form right and they don't say consent right at rush absolutely not their policy right there i mean isn't there a significant difference between a the prescribing aspirin or drawing blood or just sex right well doesn't talk with prescribing aspirin but it does talk about those other things but if you think the thing is he was on a lot of complicated medications that nine a spring he was on a lot of complicated medications there's no written consent for any of those i think that's that shows what the procedure in the custom and practice is you don't get written consent when you're giving medications the patient presence in the hospital is a consent to treatment unless he refuses and as you saw through the record there are many things that he did refuse and those things and a patient can't direct their own medical care and they often do and they certainly he certainly can refuse to have these treatments and when he did refuse it wasn't done mi but we do know what he said right don't need that and we know that the nurse interpret that as a refusal at that time gallic question to you is given the subsequent chain he for the load not for the robots he got three doses for the olympics there were many things that he he did not except at various times so he knew how to make a refusal so yes my position would be that he would refuse and he did refuse when he when he didn't want something done ok you pointed out that this is a question concerning the medical about the essence of medical battery is a lack of consent it's the unwarranted touching yes  touching one more question or the logan acts where were the c r c all calculations this minute the c s l caught calculations are not documented and according to the to the physicians they are not typically documented this documentation of that you can calculate it yourself every day and they do calculated in the koran not on the charts it's not on the charts because they knew what they were doing it's like you know when you're you don't chart it in that for the future in case there's a malpractise action you try to say you know what dosage you're ordering at the time what's going on with the patient so they got they calculate it but they don't write down everything every time until school started after all of all the well so that when you take two days off the course of treatment will could calculated it any time in the office but they didn't calculate it and then no time did it fall below the level where the dosing kind of recommended that it could be given make this the test for kidney function was done in the evening have the next morning so if you do this calculation in the evening you're using one set of figures to find out whether it's over it was better all the testimony as it was never pull up but there is no documented stated documented evidence that it was because it's not the charts but they calculated at trial under questioning by mr mcclellan getting home and i can just ask we ask you what he did refuse it later and when he refused it he didn't get it so just even looking at it in this context of this case it is clear that he did not get the loan that's when he refused it and i think that that the implication is certainly there are other medications he was on and all the other times he had refused to not take an ent that when he did take medication he was accepting it and when he didn't when he refused it he did not get it  been what was being administered in the ribs i think it pierced to me that he knew what was going on when he said i don't put them as he knew what they were he'd been under medical care for a couple of years with this dire condition that he had and i think that he was sophisticated enough to know that that's just my implication from the records obviously i don't know for sure what his thoughts were but it appears to me and i certainly can prescience the fact that they had a nurse on one day documents with it's five days the nurse even know if that bed this prior refusal had occurred if the patient accepts the medication at that time your you believe that we should believe that every nurse that came in with a bunch of there was no allegations against her we don't know for sure that he did know what he was gay but that's goes to the nurses and that's another point in this i think with regard to the the prescription it's not like they were going to d e s as a new case with these women qui completely no knowledge of what was happening they relied on the nurses to give the medication to the patient if the nurses gave the medication to the patient against his will that's i'm a nurse that is not that i'm these doctors these doctors defendants they against the doctor's for and mr mcmillan made it clear to the judge when he met his complaint because one of the issues was well wait a second well prescribing isn't touching so how can this be a battery and that discussion with the new case was discussed and it was just determined that if a page if the the doctors write a prescription and bad prescription is going against the patient's will because they have absolutely no consent at all to the medication as they did in the which i think is very distinguishable from the situation here then and then there might be a problem but that's not what happened here he took it on certain occasions he didn't take it on others ok and you are you are saying that one doctor went on the morning of june twenty second more than doubled the dose of lovenox from thirty to seventy twice a day and then on june twenty third when doctor kind of current with they at seventy milligrams twice a day that they didn't need the patient's consent to do then to acquiesce in the order i'm not sure i understand they have to do they have an obligation to explain to him going to have to change the dose here you've got a different situation you've gone into some new situation again a little bit that would have occurred at the time that dr went was saying whether it did or not she could not recall sullivan at nine o'clock on the twenty third did they go in and say to him look you're situations worse and here's what we think we need to do is you know they were never asked they were never asked i think it's so you know that  agree that a medical battery could be caused by a doctor ordering something to be done by a nurse who then follow said order in certain circumstances absolutely for example if and if a doctor given when he did when he refused  points i think that your honour's of picked up on is bad he made a refusal is documented in the chart that there is testimony by dr maurice that when she did the handoff to dr when she never told her about that morning she give agreed with the continuation of the law an ox now a liar goes otherwise i would have stopped the medication or treatment and we make a citation to the place for that in there he refused the treatment which she talks about that the treatment was stopped three days later he was in a coma with good reversible brain damage he did not refuse it again and why will stop the reason what happened was they finally  attention to the c t scan two days later and said the guy doesn't have a primary on the list we need to decrease it and that's what they did that's the c t a i'm talking about and this thing about it for the first time a trial that never said it before in fact one of the things i put in the brief was they've taken the position that the decrease in robotics three days later was a was according to the standard of care i asked dr silva it was in a deposition and what w about the contact him it made it very clear a doctor ordering a nurse to give an oral medication is battery on the part of the doctor no question about it and they try to run away from their consent procedure and i think you  brought this up for a wall this is an informed consent case it's a consent case and the top part of the consent says the consent of the patient should be attained prior to treatment in fact they have down here when you have to have a verbal consent that still needs to be recorded in the chart for routine diagnostic procedures including physically bad exam the taking of bride x rays or laboratory tests they don't give him a pass on medication then you go to the next page individual procedures requiring consent any treatment of procedure which poses a significant risk to the patient every doctor in this case admitted the woman x has assumed a significant risk of causing brain bleeds you go down to the next part it says here such consent is valid until revoked by the patient he did he wait for it was put in the child or once it happens it starts all over again and they've got to go through it and you all brought it up on this you've got to tell him what's going on why would you in the hospital if you're getting a number of medications and you said i don't want this it's been stopped why would you ever think that they're giving you something for a few moves and the sum of all every time he got it he had to have consented the last two times a guy who was in a coma so he could have consented this is something they sort of made up after the fact that oh yeah if you get it you must have consented and the thing about the other medications there was a motion eliminate was kept out there was no evidence about the other medications anything of that nature that trying to spin that in here now i just wanted to reiterate with regard to the consent that nobody established that the consent for ron paul was the standard of care and that he had no testimony presented net simply providing a policy of submitting hospital by laws or rules and regulations is not sufficient to establish psychosis he had pneumonia he had it pus in his lungs and he died of respiratory arrest and which which caused a stroke hypoxic event and then he bled into the stroke that's that is the cause of death by the time that versus anything to do with the lovenox and i think that that that there has been no showing that that is what it should be overturned i think it is it is essential to point out that simply putting a policy into play as the plaintiff has done here is not sufficient to establish a clear official case for negligence or for battery i would also submit again that the proximate cause of this man's death was his underlying medical condition which was deteriorating and had to tear it significantly since his prior discharge which is why when he came into the hospital his oxygen needs support so it danced given the fact that his own two saturation was at eighty percent there was testimony from one of the physicians and i'm sorry i can't remember which one it was who says i believe it may have a new burger but i can't recall who said that once a patient with c l o and up on a respirator which he did prior to this whole event with the brain bleed accent around i is very unlikely said they threw out oh he was going to die anyway the minute bit in the hospital three weeks before he was going to die had been to see one of these other doctors two weeks before that who said i see in another sixty days so all this question about it was so sick and effect i would refer you to i replied briefly we went through and laid out the true facts on that i also put in there about striking the statement of the case because it didn't conform to the rule nor did their statement of facts and i would ask you to do that medical battery a doctor commits medical battery by ordering their ministration or medication by another so that's what happened in this case it's a very straightforward case it's a question of fact forget the policy i don't even need the policy i've got the chart which says the patient refuses this treatment this is a question effect for the jury as to whether or not a medical battery is occur when i'm saying as the judge took this away from the jury it's the jury should decide and i think process and m very well you've got to look at the circumstances the timing and everything else like that everything i've heard counsel argue all questions of fact that's why i'm saying it should have gone to the jury on the battery count the once dr morris was taken out of the case the doctor there were six hundred orders for this man started it continued never thing else it was essentially a clear message to the jury nobody's liable so we're asking for a new trial on the on the battery current as to maurice and his tall the doctors and i would