that privilege we were going to hold perfectly and the information that came to the plaintiffs was because of the incorrect waiver denial  for the privilege to be upheld on a on a at least nice circuit basis for all institutions that engage in this type of activity will have to be decided in your case which could be quite a length of time particularly when you consider an appeal may be in the offering at the end of the at the end of the trial we could be looking to years down the road it's important for these institutions to have certainty with regard to what they conduct for activities  supporting their peer review activities and from a state law standpoint peer review has been almost sacrosanct they have recognized the state courts of recognized that it's almost in the nature of an absolute privileges i'm not sure that this issue has been thoroughly briefed from what i can tell from case law in the circuit to give them any guidance but the institutions of this nature which  across the nation provide health care in some form or fashion and specifically in the circuit and at this juncture with no one for his opinion they do function to some degree at the peril and i think many believe as good maricopa county correctional health services that private facilities why should we protect the internal investigation of a car it's exactly the same reason why you protect in a private context it's an overwhelming public policy existence of the self critical analysis privilege only in the context of medical peer review and specifically with regard to the mortality now how can you say an overwhelming public policy and congress fails  think it's exactly the same privilege you do issue i don't think it's any different than it comes to the health care delivery that's provided to them and we're not talking about the sure on the way the sure deals with the people we're talking about the health care that was provid reviewed what is really what is the care and the conduct of the nurses involved in this case that's what is that issue in that's no different than it would be in any other hospital well it is different in the sense and i think the public policy considerations are exactly the same as i said that it's health care that's been delivered and that health care can start from the minute that person has brought it on before they are actually incarcerated it doesn't really make any difference  that in fact in this case mr extra was brought to our jail no one had yet made a decision from the minute he walked in that door whether he was going to stay there or not the nurse immediately provided some health care to him it's exactly the same as if he was taken to an emergency room at a hospital he was provided health care and adverse events occurred in the connection with that in a mortality review was done in order to try to look for any type of the pattern or symptoms that might have been are centered only and if you look at the also that's provided in the in the excerpts of record it specifically serves what the limit is as to the mortality review medical care that that individual received it's absolutely no different in this context for correctional health services as it would be in the private sector they're looking to ensure that there is something that they can do better which is factors specifically to the health care peer review and so we have a more specifically to the mortality review you don't have to extend it any further  beyond that to any other situation and we don't have to but i think that the overwhelming public policy that exist in favor of conducting medical peer reviews and in particular mortality reviews and certainly if someone else can come on later obviously and take up any and say well perhaps that applies to my situation that's already been done before this court and elena that was a shipping case that kind of got the ball rolling and in that direction a soft critical analysis privilege but again i think if the court limits that specifically to can they can end up with complaints of this nature and then the still protecting the integrity of the peer review process certainly any other cases are for another day it's not before the court of this point and again i think it's distinguished by the fact there is this overwhelming public policy interest you know as far as my hour is concern i don't think our really turned on the on the rose desire for protection from their reports that they prepared time with her question so thank you our briefing we've discussed the health care quality improvement act but since then i've actually found four other statutes where congress is actually an act of very narrow versions of what you would call a peer review statute or a s an improvement in congress was presented with the issue of trying to protect doctors that was clearly intent of the statute there creating some kind of privilege but they kept it extremely narrow it only applies the peer review privilege only applies there yes except that because congress has acted in very narrow fashion recognizing the privileges only very particular situations i believe we must infer that they did not intend to apply it broadly and his facts in this case really this case is a civil rights claim for the wrongful death of an individual in a jail and so if we get to the stage balancing interests i would argue that certainly a wrongful death case based on  violation outweighs the interest in purity of privilege but i would also argue that we don't even get to that point because congress has already acted out of the you differ from the malpracti that nothing in this subchapter shall be construed as changing the liabilities or immunities under law or is preempting overriding any state law and force to members of the review process for either immunities for protection and very beginning of the statute states basically that that is restricted by acts of congress and that's why the supreme court stated that the courts must be especially reluctant when it's clear that congress has addressed issues we've already active on the other information again so it's not like the disclosure of purity it was like to the litigation itself it was just additional evidence i think it could be corrected if it was actually reversed where it can be tried again but i don't believe  a civil rights standpoint can be handled is through in camera inspection by the trial court judge childer didn't you didn't do that and i think if this court was to believe that there is a need a legitimate comes to looking at the mortality to review them so that's completely different than the operative facts that we're stuck fourth of the cases that the point of society rather what we're doing just looking at it after the fact review application of this case we're talking about tenure for a professor at a university and it was certainly not analogous to a situation where we're talking about everybody's life saving