relates to the city incarceration of my client who was a c five quad to play chicken in the correctional treatment center of the twin towers correctional facility from approximately june of because the declaration of dr dobkin was such a large part of the moving papers on the motion for summary judgment and i believe that there was an objection evidence filed with regard to that declaration and i believe that the objection should have been sustained and for the simple reason that that the i'll say the supporting documents that he reviewed in  of the fifteen locations or fifteen sites where mr dokken or dr dobson obtained medical records or or said he had reviewed medical records the only ones a pla submitted were approximately from four of those locations so there were eleven of those locations missing well the reason i'm addressing this is because i think that when you it's very important that the expert testify to evidence that's in the record and formulate his opinions and conclusions from testimony that's in the record i know there's none of the cases cited by the respondent addressed this particular issue and there is some suggestion if one goes to the use note  for the evidence section that basically the supporting evidence for the expert opinion has to be in either in the record or material that could be admitted into the record but i think in the case of a medical opinion it should be a part of the record now yeah there are two evidentiary issues all address just very quickly are they out of of the declarations of dr tiller feel off as well as the custodial officer i think its name was patrick shelley and those persons were not identified in any disclosure under rule twenty six prior to the declaration submission into testimony or declarations which were submitted in  submitted as a part of the opposing papers by roxanne wilson who was a nurse practitioner he also discounted the the declaration of the jack one more who is a nurse who is an expert in correctional care and it seemed as though that the crux of the testimony or the crux or the reason that he declined to give the nurses testimony any credence is that he had a question as to whether nurses could testify as to the issues of causation and i think it's clear in my reply brief i went through in explicit detail what a nurse practitioner could do it's also clear that defendant was essentially the person who was the attending a health care provider for the plaintiff and she was essentially you know while there's some suggestion that she was quote unquote supervised by dr wallace for all incent and sim purposes she was acting on  own treating this treating mr trujillo basically overwriting the specialists opinions that were obtained over l a county u s c when he was sent over there because he had specific problems well if in fact the nurse mahoney had these powers by virtue of being a nurse practitioner i think you can take that that testimony plus the testimony of both of the plaintiffs experts and they provide evidence of a genuine disputed fact on whether the care provided to mister trujillo was a constitutional violation you're now sort of getting closer to what was on my mind that i'd like you and make in this argument to take a hypothetical five minute assume that all the evidence think that there's also a question of fact under just a medical negligence cause of action because what what the jury has an aside is whether nurse practitioner mahoney breached the standard of practice in the community of more nurse practitioners with similar training under similar circumstances and i think the and with regard to any following that even on independent adult abuse claim the question you know the sort of the sixty four dollar question there is whether or not for him so i think under each each and all of the claims set forth in the complaint as to nurse mahoney there would be a question of fact to be determined by  rather than rather than the way it was i mean i i can't fathom that you have of you have you know dobkin on one side and there's more nurse practitioner wilson you have the testimony of karen just someone who is a registered physical therapist who has been practicing forty or fifty years and her testimony was cited in in the opposition to the motion for summary judgment i think quite liberally and her observations of what and wasn't what was and what wasn't done i think give i can't help but think it's a fact question for the jury were then an issue for the court to decide on summary judgment ok thank you events and my question i take it from what you've said that you think a little bit because also part of the claim against the county was a case under the a d a s american with with disabilities act and the rehabilitation act well you know that first of all what you have to find there is intentional discrimination and it seemed like the main point of the defense on that claim was he's katie and he's keep away so basically anything that applies to other you know that applies other prisoners in terms of you know opportunities see having that having some mental stimulation which he did not have for years  you know i did that to me would be a factual argument because just because he's k ten you don't throw his you don't lock him in the cage in and provide him with no mental stimulation i mean there are some basic rights that he's entitled to in and he was being you know in his there's a declaration in the evidence and it was prepared we before i got involved it was when i believe the a c l u was investigating the  papers and you know one of the things that mr trujillo talks about your honor is that how his treatment as a k ten was different  period your client was a pretrial detainee correct he was for the major portion of the time he was a pretrial detainee so can you tell me what period  it was i would say eighty to ninety percent of his time was as a pretrial detainee because he was involved in this criminal case there was finally a a plea with result a conviction and it seem like this i was i was visiting him during this period of time it's like a probably i would say ten percent he was convicted and he was gone yet then he would have been sent to a different state prison right right as opposed to being held in twenty hours yeah scheme and then i you know i went back to the model jury instructions last night and tried to see if they shed any light on the medical care and it really it seems like you have questions of fact and question that the the court asked my opposing counsel here was where in the record are the disputed facts and i think the discussion here so far this morning shows one of the problems which is this case proceeds at a certain level of generality that's almost meaningless that the care wasn't good or the care was good you have to look at  it was frustrating to the judge i think because for instance you know in that statement of disputed facts where the county put on evidence through dr dobkin one fact was that the  objection to dr job koreans declaration and then just mentioning declaration of his expertise not the paragraph where there would be a fact that would dispute these facts that nothing and in fact if you go to those reports it's hard to find anything about pets who aren't so it's difficult at that level i just would like to say and the medical there is no evidence in the record at all that there was any experience with spinal cord injuries and this is particularly noticeable if you come to the issue of benecol causes so let me tell you about right now you're saying trujillo encountered from his rather desperate condition of being a quadriplegic were the natural were naturally and typically associated with quadriplegia and so the question is how you how you deal with them they were not say that what was done or not done caused these problems so that was it wasn't their title as nurse that made them not competent it was the experience in training behind them because that case law on using experts in the scientific area says they have to be very specific to you have to match the expertise to the particular issue if i don't believe that was done here  i could i cite to the record for these various things that were alleged i think that the difficulty here is there are some sometimes things are alleged and then there's mr trujillo's testimony at his deposition for example ten page five fifteen he said nurses were there doing their job were two hours but he said friendlier nurses stayed longer and they talked about community of the current advance in science and computers he brought in magazines he he didn't he wasn't able to turn himself but one of the allegations was he was denied o t but then t people there that finally devised something that he could use to turn pages on his own and not have to rely on the nurses so i have the period at approximately june twentieth to july fourth chaining and at the record indicates that once he received these plants he was able to turn do you know where in that time period that was late in the time period he could turn on his own but that's because they were trying to figure out something that would work he had been sent to the hospital for that to be referred they weren't ignoring him but about as well to share his wheelchair it was an electric state of the art wheelchair this court has stated in a case that justice constitutional rights of prisoners must be considered in light of reasonable requirement of effective prison administration so much so must be a right the wheelchair was deemed a hazard in a prison setting because of its component parts that could be weaponized and because you can hide things there he was provided as an alternative with something called a jerry chair which is on wheels  that there's some evidence that he didn't want to use that but i noted that again in fourth volume of the excerpt of record on page five hundred he would sit in at three or four hours a day when he was before  doctor's order something but he was watched so carefully he was right by the nation that nurses station because he had to be he would be there was testimony was he woke from a nap and he not well and the nurse was on it isn't lean he was off to the hospital to check out what it was that they were constantly monitoring him for these things he said he was a target that's what that he asked for that status restricts you a lot you cannot be without deputy when you go to court you have to be isolated from other people you can't be just throwing the van with the other people appearing that day it's that he wanted and didn't get i mean he was treated the same as other people in that unit the television being one of the prime examples he wanted to go into the day room with the other prisoners and watch t v there but he couldn't because of his status and their concerns for that and his health so both of those things at play do you have a perspective on the notion of the aggregate effect of cumulative violations even if one in particular would you isn't it's not an enviable position obviously that mr hill was in but i you know they they tried to do the best they could and you really have to look at what he then said i mean a typical example is showers it was brought up we only had two showers a month that's terrible well in one place he said about the showers that it was his choice that was in one of those declarations that he submitted it's that the second excerpt of record pitch to ten he was reluctant to take more than one or two showers because of the discomfort of it was so awkward he was shower chair and there shower bath i'm wondering if i'm wondering they would be any anybody could be there who couldn't be treated  basis so i think on the a d a s staff i think that there were legitimate concerns first for some of the particular things that he complained about he would have liked to go to rancho los whether you can have another inmate do it for you or a deputy and some of the deputies bent the rules and the phone got dial and he said i could use the phone as much as i wanted so that picture of him flat on his back it was hard to tell the miss wilson said she reviewed medical records at the jail but then her statements were out of the complaint or the allegations they didn't relate to any particular facts  he only was able to get anybody's attention after after a substantial period of time i mean i think that that's pretty clear from the testimony and i think if you look at the