appearing before us in this soon we have a couple of extra rules are meant to the way we're doing this number one is please silence any devices that you may have with you or with anyone in the room they're only two is we don't allow audio or video recordings of this proceeding any more than we would if we were in new orleans our usual rules include answer the question that only the question that the court has put to you and the other one is that we have read your briefs and record excerpts we may not become acquainted with the every page of the record and we do to distinguish those cases in the six not the th circuit but from the from the situation for it then talk to two lane university professors who are working hard on a st date a mental health so direction and tempers cases on appeal before the judge circuit it was argued in september at least as of this morning there is no no decision on it but if the th circuit reverses that case then it will still be a c considerations since richardson have changed the balance with a concentration of large players and the correctional health care community of those players so there are a large large player all over those as works for and up and down and as i said i think they would be standing in line for chatter also the decision without any assistance or any review by anybody or should discipline after the service not now as far as we know i mean unless there's something in the twenty three pages  specifically have pats on the qualified immunity because i can't i can't believe that that's not the case of course we haven't seen them and we don't we don't know for sure i think what you're bout regardless but to present our best case we would need those suicide case is to go forward one of them was when the police had picked up a fellow just before he was about to jump off a bridge and mr guyana may have been quite or the coming in  shit in fact we know that mentally all of her took those threats seriously i would think i would take two exceptions to the characterization just respect but it has been several months it only been that he hears and she said because of the root very reason she gave for not putting him in isolation just because you consider tema so side she can't have it both what she   correctly or engaged in similar conduct that would clearly bins they want to disregard the decision whether to provide additional treatment is a matter of classic medical judgment treating him at the time and she filled in all those respects she did she not only did nothing to protect him she put him in harm's way by removing the suicide watch that was there and to the extent she took some meager measures like telling him to take his medicine and moving him to have facility that she was quieter but did not across the immediate risk and she certainly did she admitted that when she said that she was i going to put  all right thank you so next we'll hear i'm sorry i was told to do that but completely forgot i made leave the court amber picket on behalf of pelion hourly oliver who will i guess address the d arguments in the same order that mr thomas did beginning with immunity you know with respect to the cases cited by a ride upon by plane as we know that  the analysis and richard said in the subsequent cases tends to focus on the degree of supervision by the government entities as part of whether or not  there's i think any timidity with respect to the purposes served by immunity that prong of the analysis as articulated by the richardson court however in all the cases relied upon there's not really significant discussion about what exactly limited supervision means under each particular circumstance and here you know the court went plaintiff the terms of the contracts do require that c h c n n staff are required to operate within the requirements of the county's health care policies under the contract c h p was not permitted to make changes to staffing without approval to that of the sheriff background checks of the staff are performed by the county and the ability of the staff members to work at the facility was subject to final approval by the sheriff or the county the sheriff could express  satisfaction with siege the staff and if the matter was not resolved to the satisfaction of the sheriffs and c h p could not allow the person to enter the facility and provide health care services to the detainees  her making an independent determination with respect to mr gonna she did you know licensed clinical social worker but she does consult with the county with respect to housing recommendations because of the space available for in camera view by your honour's as well so that will be that that the determination of the ca ca is is part of the record on appeal but she was not disciplined you say she was required to defer to the county about housing the inmates but what is this that is in the other brief that says that she disagree with putting someone like donna in the infirmary where he would be individually nice if she says she disagree with that policy she did not she believes that isolation would worsen his condition because even though he expressed i mean there d is some her understanding as a licensed couple social worker is that you know isolation it can destabilize certain people who have suicidal tendencies and so her solution in order to keep him stable was to place him in a quieter jail settings so there's segregated cells there is a more there's a general population in there some kind of smaller housing situation with a few pods and while it does have people it's definitely less people than general population and so her solution was that to place him in the more limited quieter jail setting as opposed to general population and she did not simply release him to the general population if that answers that question and i mean she did made the determination independently with respect to the risk and where to place him but she consulted with the staff i don't want to say that they own her she did consult with them as to what was available and yes she could take someone ha suicide watch but anyone including counting step counting staff to put someone back on if they felt that observing oliver and so you know to the extent that they had some awareness of his personality and disorders if they had observed anything and wanted a subsequent mental health evaluation by mr oliver they could have put him back on and watched until several other circuits of there's no qualified it correct i'd agree that they may have that holding but i think what i was trying to point out earlier is that i think in part it's based on the level of supervision however the cases didn't analyze so we know we know from what everybody agrees side the facts i'm a solider did an intake screening and decided apparently beside a donna  while he have been suicidal she didn't she thought that she knew what to do about it what what is the can you cite any cases hell no deliberate indifference under comparable circumstances other words what's your best authority or saying no deliberate indifference i'm not sure about best authority but i liken this to i think the  this court found that the sheriff had not acted with deliberate indifference because the detainee do not give any indication of suicidal tendencies at the time and certainly i think in this instance the record reflects that miss all over determined that mr donna was not immediately suicidal and therefore in light of his mental health conditions she created a plan you know however unsuccessful that she believed would prevent mr bott as condition from  yes i believe it was i don't recall i don't believe they issued a finding that there had been any wrongdoing but i honestly couldn't so point to this ideas in the record and  state that with any degree of certainty i was i mean we've had that in other cases and i didn't know whether they did it in the case of a contract medical company as opposed to the you know the elemental one well i believe i know that there was an investigation because the records the county did provide the records for to the  basically asserting that i think that this is not a case of incorrect diagnosis and his argument that you know she didn't treat him at all i think that the record shows that   from his current and how his condition at the time differed from his current condition his part drug use his relationships and so you know and she didn't just you know tell him to take his medication but it was part of a comprehensive plan of hers to keep unstable the medication in the reference of the medication was because at the last of his last suicide attempt  he had not been on medication and so her recommendation was for him to you know an agreement to try to get him to stay on his medication so that he would remain stable so wasn't just take your medication  fine it was an acknowledgment that she had considered his prior history and evaluated in mind of his current condition and her and and factor that into her treatment plan to keep him stable so you know in addition to the medication you know she discussed with him reaching out to staff if he had a change in condition i believe within the next week when she came back from the holidays but i can't recall specifically those within the next week but i do know that a mandatory follow the  it was mandatory thought of a valuation was scheduled for mr gonna let me ask you in the jail here i presume they didn't allow him to walk into a pod with those arguments i think arise a little late the argument is based on rules fifty six deal owing for the continuance of a premature motion for summary judgment to gather evidence however plaintiffs never made a motion seeking a continuance based on the absence of those protective records plaintiffs only saw the motions seeking additional time to respond to the summary judgment motion because of technical issues with the with the counsel server  judge looked at it did they bother to raise the issue of those records and asked the court to wait until a ruling on the discovery motion before issuing any recommendations as and i guess with respect to whether or not the records are protected the defendant maintains that they are protected by the patient safety work product privilege which is established under the patient safety quality improvement act of two thousand and five the documents at issue like that as we said before worse admitted to the court in camera as part of the record the record indicates th arguments were created as part of the patient's safety evaluation system and for the purpose of reviewing patient care and for the purpose of reporting to a patient safety organization the documents were created in at war and put into a risk management system which was separate from the medical charts and the records were either reported or scheduled to be reported to the patient safety organization the records were not created to satisfy any case from of virginia corps of had a match if that's pronounced correctly but where the court determined that the statutory definition allows for unreported records to be patient safety work product because they were collected within a patient safety evaluation system the ruling was based on the court's observation that the regulations just issued by the secretary of the department of health and human services provided for a more expansive definition that protected information act collection and that is consistent with one of the x definitions of patient safety work product which includes records that identify or constitute the deliberations or analysis of a patient safety evaluation system the statute defines a patient safety evaluation system as a collection management or analysis of information for reporting to or by a patient safety organization the definition does not require the records to have actually been recorded the definition is actually notably in contrast to an alternative to alternative definition of patient safety work product under the act which protects records that are assembled or developed by a provider for reporting to a patient safety organization and are reported to a patient safety organization therefore the and provided whatever documentation was necessary to the commission and if those records that are currently you know in the record in camera for this court to review have been part of the county's disclosure they would have been contained in the records obtained by plants following up their public information records request and they were not there form and we believe the privilege applies to their records what the court ruled but its due order a pleading actually requires the court do you consider he says the address the issue after the incident at issue but over ply the law that was clearly resulting from actually actively taking him off suicide watch he says about whether other people were deliberately different after he was transferred  that well you know you've made allegations but the characteristics of people with these kinds of problems is that when they're unsupervised they don't take their medication and i