may please the court my name is fred clements i represent the connector county jail defendants this court should reverse the district court's denial of qualified immunity for two reasons first the jail staff was not deliberately indifferent five relying on the medical doctors assessment of the dissidents mental health condition second the law was not clearly established that jail officials could not rely on medical professionals to assess the risk and treat suicidal inmates to my first point that the jail staff was entitle to rely on this court on multiple occasions has stated that jail officials may rely on medical professionals decisions regarding course in fact it was the district court's opinion but there's no case that i am aware of that requires that to occur in fact the district court below did make that distinction of  or i think your honor is moving to the clearly established problem i have a way to move too quickly to the bottom line because you have so little time that i don't you know i understand your honor but no reason  did not it's clearly established that there was a requirement that there be to receive adequate psychiatric care right there are times yes that you would have to recognizes the fact that an inmate must receive adequate care psychiatric care yes your honor i did this inmate receive adequate psychiatric care dr west might be a fine doctor but he's not a psychiatrist does that make any difference in this case so what  are it's mere conjecture whether the will whether the involvement of this particular medical professional would have made any difference at all and i think this is the reason why in general this this court has has applied a medical standard to cases involving jail suicide in fact in city of pop him versus the city of talladega the case where this court first applied the indifference standard in a suicide case you know this court explain that because just suicides are analogous to foia to provide medical care deliberate indifference is the standard and so this court has been applying and say you know what if they'd brought in a psychiatrist who is an expert on suicide maybe they the jail might have taken put him on and on so it kept him on suicide watch and avoided the suicide well to answer your question two parts and it's interesting that maybe the jail would have kept him on suicide watch  suffice to say the whether or not the mental health officers involvement would have made a difference is speculative and in a motion for s there was some type of suicidal history ok because if we take the facts in the light most favorable to salter they all knew that he made an effort to commit suicide two weeks before that's not in this record no you're b because then it's a bit confusing because the the suicide effort that had taken two weeks before that actually occurred the debt connected county deputies responded to that but he was not brought to the jail jail officials did not have access to that information and the reason that he was placed on suicide watch by the intake jailer was when quote when questioning him salter simply told well i have a suicide a history of suicide there's something in the record here yes wrong at the detention center let's see a nurse testified that quote everyone at the jail knew that  not in this record yes your honor the jail nurse did testify to that that everyone knew that could could you could you read the quote one more time please everyone at the j a certain extent everyone at the jail knew that there was an issue of suicide bomb he was placed in suicide watch so obviously that was enough for him to be placed in suicide watch i'm actually more concerned because i like to look on these qualified immunity cases individually with mitchell trent and brow everyone because they're relying on dr west evaluation right this room he's got a medical and mental health history and then and he's got some psychiatric medication he's spent time dr west with them so but he's moved there from the suicide watch he's moved to the health watch so obviously what happened before was sufficient to be placed in suicide watch so i'm not very concerned with that he had problems in fact that doctor one had to get salter committed to a mental health facility and if i understand the facts correct the wife plaintiffs here they now want to sign the paperwork that's correct they were part of the bad situation or so on then i would say gets placed and the in the other and the health watch what happened and then something happened in health watch that should have let mitchell trent brown or someone know he should be put back on so as to a lot more concern with that period of time it's well to to answer your question regarding and i don't believe that there is direct evidence but he was in the he was in the circle of communication between between the doctor and the nurse ok is this your is your stronger argument that these people didn't is not the liberal the liberally indifferent we've been talking a lot about knowledge but is your stronger argument the knowledge piece or the response piece you know the fact that they responded reasonably following dr west's evaluate and removal from suicide watch i think if i'm if i'm understanding your question that i think that their response after the suicide watch was appropriate and i think  judge wilson was kind of alluding to i i believe that when you take a look at what it requires to probate someone perhaps it was an incorrect decision by the doctor let's assume that that decision was incorrect well the doctor wanted to get him into a psychiatric treatment oh yes your honor but let's assume that the that the decision assuming that the decision was incorrect to take him off suicide watch the  after their knowledge of his suicide their response was that they failed to follow the details written policies but i think i need to i think i need to clarify the record he was put on suicide watch initially by the nature that it constituted deliberate indifference well this court has consistently held that a violation of jail policy does not equate to a constitutional violation the united states supreme court in taylor b bar kess stated that there is no clearly established right to constitutional jail policies and in and i think the more important application of barca's to this case in the light of clearly established law is what about the evidence the suicide watch protocol they were to monitor every fifteen minutes under the lesser height and watch of medical watch that was not a requirement i thought he went thirty minutes with me and he may have but that was not a requirement under the suicide watch that he sees me the medical watched that he was placed on by the jail doctor or guess guess what i'm getting is there seems to be a lot of well i think ultimately this case beyond if we go beyond the issues of fact i think and to go back to judge newsom's question about what the strongest argument is i think our strongest argument is that the law was not clearly established that  has indicated that they believe that a doctor or professional should be within their area of professional expertise so we're going to require it for ruin your favor right it's a requirement that a not just a medical doctor who did all these things that dr west did he goes he did a lot right even try to get him committed it was there we you need every jail has to have a psychiatry there i think what we're looking at is not necessarily but what we do have to have is a level of expertise that fits the situation i think what we're looking at here is we're putting the cart before the horse infirmary says brennan we have a subjective test and we have an objective test it's a subjective test starts with is there a likelihood is there subjective knowledge in the defendants that they thought suicide was a likely has substantial likelihood or what's the word  i believe it is a substantial likelihood is pretty big which is very big and i believe it and everyone admits that there was at some point that every one of the defendants had that substantial like some of the problem i have with this is because it's a suicide as opposed to a lot of other cases and maybe because apparently lately there have been so many suicides and perhaps many of us have at those issues so i'm thinking how qualified immunity appl the officer kept and the people that corrections officers who are there and with suicides you have individuals who seem to have happy families sometimes they don't have good finances and all of a sudden because of depression they commit suicide and spouses and friends and coworkers don't even know about it or if they know about it it's hard to prevent would you concede that was suicide there the instances like that can happen in history it happens a lot it seems like it where the family members don't even know him feel very guilty and then we have qualified immunity for prison guards basically right where what are they supposed to do the doctor says do this move them from here to there look at him every fifteen minutes every thirty minutes when he's in suicide watch he has no clothes right except the boxer shorts when he's in he rely on the very professional their policies mandate them to go to not suggestive but mandated policies you will if you believe there is evidence of suicide which there clearly was from the second he was booked in from this booking sheet you must contact the southwest mental health mental health professional for a face to face evaluation why didn't your wife want to commit him is that dr west want your honor i understand that that's that's an trial argument for the defendants but the point of it is we're talking about defendants who under the constitution and the eight the memmott have an obligation to keep this man safe now they may not have liked it and they may have felt he should have been somewhere else but while he was in their care testify and did say that he was not contacted for a face to face he was not brought on he did not have a bit about that given the facts as the plaintiffs have stated them he would have put him on a suicide watch he would have taken away his clothes he would have taken away his belt he would have put them in a in a in a suicide resistant cell by the way your honor this jail did not have a jail suicide resistant cell and we must look at this is a sliding scale hold on before we get to the rest of the suicide resistant so i just want to sort of make sure i've got my medical professional piece of this case squared away yes or so but i mean is it your position sort of micromanaging these prison guards decisions so you're saying like a no no no you can't rely on a generalist even though he has an m d you've got to rely on the therapist even though he doesn't have an indian can't prescribe medications i just sort of i mean aren't the prison guards thinking like well this guy might need medications maybe west in that respect is better than then this other therapist got out of there is a psychiatrist available through southwest alabama clinic and he's available through through the very mr bryant so the question is i understand the doctor who was on contract with the county by the way not the sheriff he could prescribe but he's a he's a  with a limited understanding i'm not saying he has no understanding and i'm not saying that he wasn't trying i'm saying that the jail by the sheriff recognized through its own mandatory policies what it was supposed to do and it completely violated  west had recommended that your client be put on suicide watch would you have expected the jailers to defer to that decision quote i would have hoped so yes why not also are they allowed to defer to his decision to take him off suicide watch if west is sort of smart enough to get him on suicide watch in the jail or should pay attention to that why not smart enough to take him off west and not put him on susan or no i know i'm just if i think that we would all hope and expect that jailers would defer to a generalist indy's decision that this fellow ought to be on suicide watch and if we agree about that then i don't think i understand why it is that they  ought not be able to defer to his decision to take him off his let's step back a second one of the problems we're facing here is i think what he's trying to get is farmer versus brennan has its objective and it has its object of requirements the subjective is the one that we've been talking about but it's already been established whether there is a step substantial likelihood of risk that was already established so now we where they try to raise the doctors for the second the object of reasonable remedy that's wh happens and it was up to the administrator and the others to look at the reasonable remedy there reasonable remedy is to defer to west in everything carte blanche put him in health watch which is different from general population where  allowed officer harrelson the souter's friend to visit him they check them out every every fifteen thirty minutes right it's true but it was it was clearly insufficient and it was insufficient based upon the hindsight obviously it was clearly insufficient like everyone would think in every suicide we should have done this we should have done that but there's so much it's so difficult for them not to have qualified immunity when someone is in health watch already what else could they have done i guess what we're saying bottom line your honour's jury question as to whether there was deliberate indifference whether there were reasonable response under farm it was reasonable and i believe that the court of the district court gave many reasons to establish once that there had been established that there was subjective knowledge and everyone admitted that there was then whether the reasonable response was was one that was reasonable under farmer we say that reasonable when you say everyone admitted who is everyone who had met it that there's a substantial likelihood that something was going to have everyone knew that had mental health issues and that he was being they were making an attempt to probate him they were his attempt to make him committed mr mitchell said in testimony i understood he was a danger to himself and to others and your honor listen to this where did you get that i asked mr mitchell where did you get that information from the nurse from the doctor and from the staff now if those people who they represent are aware of that danger and letting the administrator know then all of them by the his own testimony has subjective knowledge of the risk then the question becomes for the jury what is the reasonable reaction as former the second requirement what is the reasonable reaction the district court found that a reasonable reaction are those things that are in their policies take away put him in jail resistance cell take away his clothes do close monitoring none of which were done and your honor that's not just the policy we're not asking you to enforce the policy that's no versus city of citronelle but so your rights of the district court says a reasonable reaction is to do those things yes or your burden on a qualified immunity case right is to prove that a reasonable reaction was not what they did to defer to west's judgment that he should be taken off so that he could be taken on suicide watch and monitored throughout the watch  and we believe that snow versus a journal gives us that clearly established that the clear clear notice required underlain year because look what happened in snow with much less evidence what much less notice of the guy's suicidal proclivities one she had one wrist cutting that was done some time before they don't even give days and information from the family that he was suicidal this fellow tional didn't take any action to inform the other officers and so they asked tional what would you have done i would have taken away his clothes i would have sent him back for more check up at the university of south alabama i would have to sell resistant and i would have put him in the drunk take tank which was circuit said yes that is essentially acceptable reasonable responses under former not only that but if the other officers had known they might have done more they might have done it because it would have been under a they would have used closer closer of any or something to that because you have a better handle on snow than i do i'm sure but so in snow you're saying that that when those that when those steps were taken the eleventh said good enough they said those but let me first say that snow didn't have a policy they had an unwritten policy so they asked in the case they asked the officer what would you have done if you had if you had thought he was suicidal and he listed those things and the court articulated those things and then said specifically if that if the officers had known the chanel failed to alert the other officers if they had known they would have not could have not only done those but they could have actually done more close monitoring tional actually is interesting because the snow died with less snow was being monitored less than fifteen minutes apart and he had to say and yet your circuit said well that's good but if if the rest of the officer had said taken it seriously and known about it maybe they would have done even more close monitoring so i think basically snow gives help me out here with this objective knowledge because i want to get to that first yesterday and i know you get to it real quickly tell me the difference between brown tran dimensional as to what they subjectively knew of the suicide risk i've got a list and here's all have all have to paraphrase it the guard at the end had all kinds of knowledge she knew his son and she there was what this is a small community or into a small jail and everybody talks so i don't you know you've got to have the evidence of what they subjectively knew and you keep are you want to do it collectively honor i'm sorry i believe our brief lays out because there's a lot it is a lot i would dare say that our case has more independent information interment knowledge of each defendant than any case that i've read research into this maybe with the exception that poor guy who mutilated themselves thirty years ago whatever that was a delight but there is an awful lot of knowledge lot of circumstantial i understand but that's allowed under under brown or brennan farmer versus brown and so we've got we've got pate brown the guard who had lots of information heard lots of things she admitted she knew them from the family she knew about the previous suicide attempts both of them she knew about being probated in two thousand and nine she said there was lots of talk among the jail so it was all discussed mitchell of course not only knew all of those things because he had fact had been in the been a straighter not only when when brown came in and i'm sorry when when the deceased came in in two thousand nine the year before you know which was the third third instance had been in the jail but he had heard about the time a guy named mr raven had committed suicide in the connected county jail in two thousand and six same thing suicide cell it's nigh dentical copycat not a copycat but it's a it's a clear warning to the whole jail that this was going to happen again so there's that knowledge trent your honor knew the least of it i will admit a lot of  information came from being there she was the captain on duty when the fella came into the jail she was probably the person who put him on suicide suicide watch because that's her job didn't contact anybody at mental health and then a lot of the information she got from logs and things like that but will admit the trend has the most circumstantial of the evidence so i'm sure you've covered this but let me ask you again if we look at snow and we cases different then snow this your honor snow was not there very long mr mr are deceased was in the jail for seven days and eight days of which there was day after day a deterioration in his situation all known by the officers and in particular by mr mitchell on the night of his death knowing that that you have each of the instance on march first he didn't eat on march second he had to be put in a restraint chair on march fifth he thought he was being bit by ants on march sevent has some kind of other indication all of these things would have been known by the administrator and yet on the night of april ninth the person who was supposed to be in charge of him was assigned a different duty in violation of the clear violation of the jail policies that there shouldn't be an officer mr ms brown doing to do these and in the situation where the administrator mr mitchell knew it was impossible for her to do impossible for her to do he always short staffed there was nobody watching him it is luck that he was seen at all because he was fed at four o'clock and then when they went to get his food he was dead some you know twenty thirty minutes later so the administr or with all the knowledge he had knowing that he had to be commit was going to be committed and probated knowing his whole history allowed that understaffing and him not to be monitored at all so as it is it is it your contention that sort of we've talked a lot about knowledge given what these do these defendants knew that they should have ignore countermanded discounted the doctor determination to take him off suicide watch not stand down but you know sort of ok we're in a different place here that they should have remained static sort of death con five your honor i don't discount that there is a dilemma for folks especially the lower level folks but how versus evans is a great case for putting for the exact same situation where public officer said you know what we're going to contract out my brain on these decisions to medical specialists i'm not even going to make decisions because  the doctors are the best ones to know and the eleventh circuit said very strongly you can't do that because that becomes a policy of indifference and when you're a small town guy in a small town jail and your life depends on being fed inside of walls and being housed inside of walls and everybody knows that you're a had jail and suicidal proclivities it puts a burden on every single person it opens and closes that keep some more than others but every person because they're controlling his life and in this indication they let that guy die because with full knowledge with full subjective knowledge of his proclivities they they were housing him in an unsafe place and not monitoring  again i would like to address judge wilson's question from earlier regarding questions of fact and your honor is correct that there are there potentially are questions of fact but if this is a qualified a if this is a clearly established law issue there are not because it is not a question of fact that dr west took mr salter off suicide watch it is not a question of fact in the district court found that the jail staff relied on the doctor it is not a question  fact that the jailers reported any odd instances to the medical staff and so this really comes down to is the law clearly established that jailers cannot rely on medical professionals in mental health situations and  violation of the policies is not sufficient to show deliberate indifference and even though the custom that was done at the jail to go through the doctor failed it was not in and of itself is a deliberate indifference custom to go through the doctor to contact the medical professional to update medical so that the doctor had the most up to date information and and so do you know what the policy is to place someone in health watch versus general population because surely you have in every jail people with mental health issues that may not rise to the level of suicidal tendencies is there anything in the record about that  nothing but their underwear and you can actually take judicial notice of the weather at that time it was between thirty and fifty degrees at that time and so this isn't yet so you're going to actually want to be have his possessions as well as a blanket but he was kept up from where he could be monitored more closely is there another level in addition to a general population or those are the three to my knowledge in the only thing that was in the record at least in the jail at i think it's closer to seventeen but you know admittedly we are going off of hand written records it's an estimation of the time that that needs to the jail staff left leave his cell door open for twenty thirty minute intervals to alleviate his claustrophobia was under the doctor's orders yes and so it goes back to the fact that not only were they relying on the doctor they were following his orders they have the power to contact the mental health professional could they have the policy did not forbid them from contacting mental health know but typically under the custom the medical staff was handling that they have the of authority to do that collar under the under the policy i believe that any anyone could be administrator testified that you know generally if someone would do that he would do that although it was medical that was that was doing that in fact the nurse johnson stated that she was aware when confronted with the policy of contacting she stated that she knew of the policy and that she contacted mental health in accordance with that policy and to an extent we're kind of getting into semantics here about it us a jail policy that says that some type of jail official must contact mental health but you know if you get us through it can but we did have a jail official who contacted mental health and that's not in dispute because the nurse although she may have been employed by someone else was working in a capacity as a nurse at that jail and so why doesn't that fit the description of a jail official because aren't we just looking at pierce the man takes versus the spirit of what the policy was about and i guess without respect to the to the policy or what the jailers in this are in this situation could have done from qualified immunity for qualified immunity purposes was there a law clearly warning these prison officials that they had to contact a mental health professional that relying on the generalist wasn't good enough no on generally there is there is no you're out of there is there is no law that established that would that would require them to do so especially given the fact that it was understood that that medical