even the defendants don't defend the district court's reasoning and refusing to permit mr clover to add claims against the one prison official for sponsible for the constitutional violation dr ryan holds instead they seek a firm inside alternative constitutional violations and so has repeatedly said that refusal to permit a pro se civil rights plaintiff to amend a complaint to add claims against responsible officials is widely recognized as an abuse of discretion nothing about this case handful of cases in which the lay was held to justify denial of leave to him but each of those cases involves counsel to plaintiffs and so doesn't work here we say that it's an abuse of discretion to refuse to prevent a civil rights plaintiff proceeding pro se to add claims against the right defendants the defendants can't defeat that argument by reference to cases involving counsel plaintiffs so that's the law on the facts mr glover delayed just over two weeks between learning of the facts necessitating amendment and moving to amend nothing in the cases cited by defendant suggest that even in the case of a counsel to let again a two week delay is sufficient to qualify as on to do and in addition as we explained in our brief delay alone is not enough it has to be coupled coupled with some other justification like credulous facts and showing a prejudice is wholly absent is in terms of custody health and whether he wants an injunction he is not in custody his long term health was compromised by the denial of the cialis prescription and he does not want an injunction  summary judgment for everybody who else other than dr holds water was correct we are not challenging personal involvement as to the admission on the issue of qualified immunity i'd like to start by emphasizing just how narrow the question before that a plaintiff who shows the existence of a serious medical condition doesn't necessarily have a winning th amendment claim in this context where the serious medical condition is based on the recommendation of a specialist outside the prison that plaintiff has precisely half of an th amendment claim and frankly it's the easy half all the prescription does is trigger is trigger an obligation on the part of the prison physician to exercise independent medical judgment in deciding whether the outside recommendation is appropriate or don't need what the supreme court in the have repeatedly said we don't need is a mirror image case but actually identical case which means that we don't need a case about erectile dysfunction given that i think that gutierrez and the cases following it take us all the way entire distance that we need to go gutierrez after dropping a two pronged destructive test for the existence of a serious medical condition with the st prong being whether a physician has concluded that the condition mandates treatment assess the existence of such a condition by asking whether the two doctors that issue in that case had prescribed treatment for the plaintiff and found that they had the court then said these physicians clearly regard the plaintiff as having a condition mandating treatment because when the plaintiff went to see them about his condition the defense never explained why given the existence of that clear categorical rule some doctor holds mockers position could have assessed the facts of this case and concluded that mr glover did not suffer from a serious medical condition instead they point to other cases involving a wreck tile dysfunction but none of them help them at all here to make toffee case in particular which is the one published court of appeals case that they cite comes from the rd circuit and make tough he takes an approach to all fight immunity that this court has repeatedly said is flatly can correct in the an interest in not promoting sexual behavior on the part of inmates to your knowledge does cialis have  an impact on a on a patients sex drive and would that be irrelevant factor for a person to consider as far as i understand the record your honor we know that  cialis can help the patient in maintaining an erection but i don't know that there's anything in the record suggests suggesting that it has an effect on the patient's sex drive and as i understand the arguments that are advanced by the defendants there's no suggestion suggestion that there are you know institutional needs in prison that would permit the prison to decide that you know administrative concerns overrode their ordinary obligation to provide adequate medical care to inmates and adequate medical can be you know potentially dangerous side effects to medications like cialis it is a prison infirmary equipped to handle those side effects but your honor i think that a prison infirmary is set up in order to provide adequate medical care to prisoners and there's nothing in this court's case law suggests that in the realm of health care for prisoners sexual health care should be categorically closed off and of course if if cialis did result in adverse side effects that were for some reason particularly undesirable in the prison context then those medical concerns could be taken into account by a prison physician like dr paul's mocker this is precisely why we require prison physicians to exercise their independent medical judgment once the existence of a serious medical condition to show his doctor holds worker's affidavit look to you of the description of a medical judgment or a policy judgment about providing erectile disfunction treatment in prison generally so i don't think that it looks like a medical judgment in the way that this court has used that phrase at most i think that dr holds mockers declaration suggests potential reasons for the existence of a generally a political policy that does not permit inmates to have c l s but it does not represent a medical judgment in the sense of the independent exercise of medical considerations taking into account the patients good afternoon i'm wisconsin assistant attorney general carla key caber and i represent the defendants of pelleas who are several wisconsin prison officials as opposing counsel alluded to the issues on appeal have been significantly narrowed through the briefing in this case so that the only issue before the court is whether the district court abused its discretion in denying mr glover's request to add dr who it's not her as defendant the record here supports the district court's decision because mr glover und filing his request the request would cause prejudice to the defendants and because any amendment would be futile as dr holt's mocker would be entitled to qualified immunity starting with the lame mr glover waited until the middle of summary judgment briefing which was almost eight months after the case began to file his st request to amend and this delay was the result of his own actions there was a long delay while he refused to sign a medical re the court allowed him numerous opportunities to proceed and to sign the medical release four months there was back and forth with the pope with counsel and with the court trying to get an a valid medical release signed a mr glover refused and then ultimately had a very narrow release obviously he was he was difficult to deal with the doesn't necessarily justify this remedy and i hope this this problem without access to medical records frankly is mystif judges power to manage discovery and to dismiss the case of the point of his noncompliance at the time that mr glover filed his request to amend the district court was not it was not abuse of discretion for the district court to not give mr glover yet another chance to either sign a medical release or proceed or to order over his objection the submission of medical records what prejudice w to start over again as the doctor holds not everybody else is out of it right well this was in the middle of summer a general so we didn't know that at the time but yes there might have ben you know we don't know what would have happened there may have been some a dip delay to the the existing of supposed to figure this out well that's it correct he he filed discovery at the soonest opportunity as soon as he signed that medical release he submitted a request for discovery asking all the right questions and the defendants provided all the information he needed things that he asked that were the appropriate questions to ascertain the correct a friend at work who is responsible for placing medications on the formulary and the defendants responded that that's the pharmacy in their pewters committee and they listed all the members of that committee which included the medical director would old members of that committee be appropriate defendants in the case possibly if that's the claim he filed but we don't know the exact claim that he's intending to file because there was no amended complaint to nd question he asked was who's responsible for  formulary request with the name of the person who denied at and defendants submitted that form with dr holtz mockers electronic signature clearly at the bottom and this wasn't the needle in the haystack situation that opposing counsel suggest because each see a lot of prejudice in that direction well again with the medical director with the medical records neither doctor holds mocker nor that i think the department of justice could see any any additional medical records or obtain those without the medical rel without a court order or court order over the most solvable problem i've seen in a long time again we're looking at the abuse of discretion standard of review if your discretion was not exercised on this basis well moving on to futility so dysfunction as a serious medical need requiring treatment make tubby do we need to reach qualified immunity before he's even in the case i mean isn't that an argument for him to make at the appropriate time ordinarily we when we're doing abuse of discretion review we focus on the reasons the judge actually did rather than imagining one of ways that if we put it a different one would it have been an abuse of discretion in your view to have a while the amendment in this case along with workers to make sure that there was full access to all needed medical records immediately perhaps not but again the court didn't but as far as futility goes i think that is a basis to affirm the district court's decision the court didn't address qualified immunity for than current existing defendants because those defendants very dismissed on personal involvement  grounds but in cases like theory and the court did address alternative grounds especially when the district court's decision was insufficient or there wasn't enough information to it to decide how t to this case where after process surgery an inmate with was diagnosed with sexual dysfunction and his outside the prison doctor prescribed a medication for that problem and his in the prison doctors denied that medication the district court in that case defined the right very broadly as a right to treatment of a serious medical need or the right to procreate and found that there was no part fight immunity but the rd circuit said that that find the right to broadly and that stead it had to be defined as whether prison officials are obligated to treat conditions resulting in impotence or infertility such as retrograde ejaculation or erectile dysfunction so disease by disease not disease by disease but that there individualized medical judgment about the condition that as it may affect mr glover well i would argue that in this situation where we're talking about whether it's a serious medical need at all individual go to a different profile for the inmate who has this medical history suppose he's not a sex offender he's somebody who committed many croyde forty five years old a three year gets out of will that again is not been established in the record and may go to may go to whether they're ultimately is a serious medical need found in this case but you think that might have had something to do with the doctor's prescription  clear from the record again neither dr murphy nor dr we ordered that treatment was mandatory in this case just based on the facts alone dr murray recommended the treatment dr we in his  formally request said it was a non urgent medical request so neither doctor just on the fact indicated that it was me and mandatory treatment is that ordinary ordinarily done and do they distinguish between recommendations and the prison i believe if there was a medical a medication that was you know life or death kind of medication certainly they would indicate that in the orders or and in the non formally request that is that is certainly not this case it you know even if we assume that mr glover could ultimately so a serious medical need based on these facts that was not it was not clearly established as a serious medical need requiring treatment at the time that dr acted  thank you your honor a couple of points the defendants have pointed out that nothing in the prescription regarding cialis said that this was a life or death medical condition but that's precisely the test that gutierrez says we don't apply we don't need distinguish between treatments that doctors think are just important or appropriate and the ones that they think are mandatory runs headlong into the principle from gutierrez that courts aren't supposed to be involved in making medical judgments let's get here as emphasizes deference