and their right to summary judgment is free and clear from doubt as a high standard and the only question in this case is whether the record last or the nearest cause because there is a chronology in this case involving two hospital as we know it is uniquely in classically a question of fact for the jury that is especially true in medical malpractise cases that's because those cases are very complex they are fact driven and doctor now with a film that sure was a bleed and a film that doesn't show the lead pass to err on the side of caution and admit that patients on the basis of the bleed on the  regard i believe on this record that's a matter of dispute as to whether the doctors at lutheran general actually believed to but the question is is th kemal swedish company correct now and an analysis that was contradicted three hours or four hours after opinion that there was no bleed in then a within four hours of the refusal of the patient to be treated at their location given presumably the information it was serious who immediately goes lutheran general opportunity to be admitted at swedish and goes to another hospital where she's treated by two whether doctors to do with a good in then she unfortunately days three days later so the it's misread the decision making is made on the basis of that read that is no separate self contained transaction and anything that happens  she's called back you can judge the case against dr kemal from the standpoint of causation as falce ralph will have happened immediately a craving to the she was sent home she did not refuse any care and that is a phrase that is very prejudicial and it's used a lot by the defendants to characterize what happened here what happened here is baf when she came back you know she was even firing the recommendation to come back she's terrible by the hospital by the way you have a brain bleed in your head it's not twenty four hours of study active setting there's no question three o'clock in the morning she's told she doesn't have a bleacher goes home seven or eight o'clock in the morning she's called come on back in she gets her at nine o'clock in the morning the treatment yet lutheran general general was inadequate insufficient or was it was certainly impacted us so tell us why it's because they didn't do that that she wound up that it was a  that's a good question it's one of best myself i can't i think it was a standard or rather it was just a date that the curve had sat and i don't know how to answer the question frankly what somebody else did three or four hours or five hours what if right right that minute big difference karen that because she left the hospital and went to lutheran general and refused  off and we said the case in our brief that says that the refusal of care as relevant as it may be relevant in this case that's a question of fact for the jury to determine whether perhaps as a re received no treatment for it she had the same high blood pressure that with her in general she got no treatment for that so it is a continuing and is a it's progressing and back to my point about the ten that is the opportunity when she's in the hospital they have her she has refused any care she goes there by ambulance she's there for fifty six hours she had the opportunity at any point along that line to say hey i want to go somewhere else she didn't do that or should have been done by swedish confident ever the better they did on the th to beat a dead horse has nothing to do with the causal chain on the th and that the evidence shows refused it mission at nine o'clock in the morning she would not or she would also refused admission of three o'clock because we had a difference a day makes when she's brought back now we have a situation where er that she would have stayed at sweeps if that's the question there is plenty of evidence she was taken there she either one of the factors kellog impale read it properly should have been treated luthor in general for blood pressure and it would nab him she would not have suffered the other bully that ultimately killed  point forward as a patient with a confirmed brain now the her situation up at lutheran general because they didn't have the scans i think is a question of fact as to whether there's doctors really believe that she had a brain bleed i don't think that's appropriate for the trial court to do that purdy's objected to the procedure now there's is it a no standing order or is it the order to specifically grant for this that i don't know but i do know that there is nothing the record indicating that any party asked for a continuance kemal and his initial reading of the c t scan is it certainly had absolutely no impact on anything anybody did at lutheran general there's no evidence that any doctor there testified that they were then then there would be an opportunity to determine whether what the proximate cause opinions were and whether there was any break in their causal relationship that will have prevented this the injury that led to her death so i don't think that we need to go down that road after the stage i think that it was enough as the circuit profound that miss paris decision to seek treatment there's no evidence of that if there is a question of fact that gets to the jury we have to ask ourselves is there something in the record too is there evidence in the record to justify giving this question to the jury there  you probably don't listen to a sense of what i'd like to say it is it doesn't matter if it's appropriate or inappropriate because it didn't make a difference the issues and the rip current are not two different pieces of information there are two different methods of conveying a the scam dr bell has testified seven times that even when the patient walks in with the images in her hand we repeat the state of our equipment to read be read by our radiologists then to both that's to your understanding the basis for their claim like me only for swedish in addition to perhaps the agency ruling dismissing swedish from the case was really based that breaking the causal chain it wasn't an issue breached the are not complete in your discovery and in my volunteered admonishment to everybody is if you get a standing orders from any motion judge or any judge that doesn't  salutes an order and may should do things that just don't fit with a reasonable handling of of a lawsuit so with the help i appreciate that observation message received no it's not to you to supplement and perhaps to answer any questions i just fierce or in any either of you may have i just i want to reiterate that we have to address this right or we are not ignoring the standard of care is really the opposite in in general so there's no injury according to him so what's wrong with him having different if you believe that to be different as right around with having slightly different theories but that he can't he can't change the fact if we don't know what the proximate cause was it seems to me that there is there is there is enough evidence here and the clearest of the events without determining and just to reiterate no no it's come up before but it's important to my case misfile state that we discover for fifty six hours she was taking her she could have chosen if she had such strong feelings that she would never consent to be